"I hate to say that my favorite writer is very depressing, but it's true," he said. He was speaking, of course, of 1980s short story writer and poet, the seminal minimalist Raymond Carver, whose work Silberman called both "hopeful" and "doomed."

Carver's "strained relationships" influenced Hospice, Silberman said, and it's believable. He also admitted to "coincidentally" watching a lot of Six Feet Under, the HBO series about a dysfunctional family and the funeral home they own.

"I've always been fascinated by things about the awareness of death and morality," he said. "It's so obvious: 'Everyone you know will some day die,'" he went on, quoting The Flaming Lips. "I'm really fascinated by how we can ignore that on a day to day basis."

Speaking of The Flaming Lips, there's a certain type of concept album that music listeners yearn for when they feel like injecting personal meaning into a piece of art. But this specific sort of record is hard to come by, so people end up settling for vague conceptual opuses like Midlake's The Trials of Van Occupanther. Chuck Klosterman was likely craving one of these affecting, cryptic and narrative-based LPs when he concoted that preposterous theory about how Radiohead's Kid A predicated September 11th.

Neutral Milk Hotel's In the Aeroplane Over The Sea is a concept album that works, transcending its moment and telling an indecipherable story with universal themes. Cursive's Domestica touches on the power of a thematic thruline, and although betrayal and anger trend toward universal, divorce is too specific. "It makes more sense for a record to not to be all spelled out," Silberman said. "I think it's more important for other people to develop a relationship with it."

And anyway, Hospice is much sadder than all of that. It's a hurricane of a record, set in a cancer ward, which tells a story of an invested caregiver, the album's first person voice. Silberman plays the role convincingly as a singer and writer, wailing about phantom pains and nightmares as his healthy narrator becomes the infected thanks to a destructive and alluring patient.

I wish that I had known in that first minute we met, the unpayable debt that I owed you. Because you'd been abused by the bone that refused you, and you hired me to make up for that.

These are the first words on the album and they set up the black hole of an extended metaphor which carries through most of the ten songs. Occasionally, we leave the hospice and it's clear that Silberman is speaking, at least in part, about a fractured and destructive romantic relationship.

This second character on the record is, in one song, referred to as Sylvia, a composite of a real person in Silberman's life and two literary figures. One is the first wife of the writer Leonard Michaels, Sylvia Boch, who committed suicide and is depicted in the fictionalized memoir Sylvia. The second is Sylvia Plath. Sylvia, get your head out of the oven. Go back to screaming and cursing, remind me again how everyone betrayed you, Silberman sings.

"I decided that I wasn't ever going to explain exactly what the record is about, partly for my sake and partly for the people it's based on," he said. "It's not an attempt to be difficult. It's just the fair thing to do considering that the person depicted in the record is not depicted positively. While I might stand behind that, I don't want to make life miserable for that person," he continued. But, based on the album, she sounds like she's doing well enough at that on her own. If she is, in fact, a woman.

"It's a strong female personality, but can also be a very destructive one," he said, before correcting himself. "It doesn't have to be a female personality -- it can be a male personality."

When asked if he would consider any of the record fictional, he admitted that it's a gray area. "In a way it's 100% true, but it's told through analogy," he said. "Nothing on this record is fictional except the metaphor through which it's told."

This metaphor, which is explored in songs like "Atrophy," "Shiva," and "Wake," makes Hospice a brutal record. It's painful to listen to, something Silberman took into account during its making. "I knew that it was going to be uncomforatble to hear and I was just hoping it wouldn't cross the line," he said.

He confessed that he hadn't listened to the album in a while. "It's kind of like watching a video of yourself in high school," he said. "It's almost cringeworthy." Silberman started work on Hospice at the age of 21, after a year of isolation in a Manhattan apartment, but when he says now that the songs sound like someone else, it feels healthy, like he's moved on.

"On the surface it's a depresing album but the intent is not to tell a sad story," he said. "It's about dynamics. The lower you go, the higher the high is when you pull yourself out of it." He continued: "You know that horribly stupid expression? You can't appreciate the sun without the rain, or whatever the hell it is? It's sort of like that. You can't appreciate your independence and emotinoal freedom until you've had it taken away from you."

Intermittently, mainly in the album's middle section, the story breaks from illness to speak candidly about a young couple and New York City, as well as to address the emotional abuse at the story's core. "Bear" tells, seemingly, of an abortion coinciding with a twenty-first birthday. There's a bear inside your stomach, a cub's been kicking from within, the song begins. And you'll just keep me in the waiting room, and all the while, I'll know we're not, and not getting un-fucked soon. The song's refrain is an argument: We're too old, one contends. We're not old at all, says the other.

"Two" tells the real-life story most directly. When we moved here together we were so disappointed, Silberman sings. I didn't mind you blaming me for your mistakes. "I wanted to make people more aware of that kind of relationship," he said. "Not a physcially abusive one, more of a brainwashing -- wearing somebody down until they can't think for themselves."

"It's a relationship of blame and it's very one-sided," he continued. "People become convinced that they're powerless or wrong all the time. That they're responsible for things that they cannot possibly be resonsible for. As for Hospice? "In the case of this record, it's about the caretaker thinking they are responsible for terminal illness, which is completely ridiculous."

Silberman describes the record as being about the extent to which guilt can lead us to betray ourselves, yet he insists that he has learned that lesson that now. "People need to be responsible for their own lives," he said. But as he spoke, it seemed as if he was still wrestling with the ideas he has addressed. "It's a very important and romantic thing. But at the same time, there's a limit," he said, and it sounded like he was telling himself.