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The "mental patient" thing was done by SPK in the late 70's, and it's been oft mentioned that one of their members in their peak early 80's period was a former patient himself (I think he's the one taking bites out of a rotting cow's head in the "Despair" video).
As for extremity? Hmm, one person's extreme hell music is another person's "meh". Oh course, there's also extreme tunefulness, quietness etc etc.
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Snow on Easter Sunday - Jesus Christ in reverse.
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