"When I was around two, I loved to slide on freshly mopped linoleum floors," Dominick Fernow said. "It might even be my earliest memory. I would run and slide, and once, I cracked my head open on a dishwasher. You can see the scar." He points to his forehead. "I was rushed to the hospital and I was so hysterical that they put me into a straitjacket. Suddenly it was turned into this deep memory of being in a fucking straitjacket, a flat palette with velcro straps that folded on top of me."

Fernow is one of the world's most prominent noise musicians. He makes relentlessly dark and confrontational music that runs the gamut from noise to techno to ambient, and contorts himself into bent, jagged shapes in his throat-shredding live performances. He traces his anxious and misanthropic streak back to that childhood incident, and the memory of the straitjacket, which he said is "clearly the root of these issues." It comes from other things as well: being raised in a religious household, a certain self-loathing and a general disdain for the world.

"I did a lot of personal work to try and understand why," he said. "Why do I hate the person sitting next to me? Why do I hate that the ceiling is rounded and not square? I realized that I had obsessive compulsive disorder. OCD is what allows me to sit there and cut out a thousand tape covers by hand with a pair of scissors. And to concentrate on tracks. But it's also this constant torture. And techno has forced me to deal with these issues. It's forcing you to be in the moment."

Fernow told me this an hour and a half into our interview, after I went to stop the recording. "No. It's boring, I didn't give you enough," he insisted. Despite being absent on social media and having few interviews to his name, Fernow was eager to talk. We end up spending five hours together, eventually moving to a Russian bar in Friedrichshain where he speaks more freely, loosened by earl grey with Jameson.

We began the interview in the offices above Berghain, the world's most famous nightclub. It's a location that would have seemed totally nuts for Fernow, once a luminary of America's extreme DIY and noise scene, just a few years ago. At this point, though, his life—both personal and professional—revolves around techno. It's been a gradual shift that started in 2011 with Fernow's first release as Vatican Shadow, an experimental alias that has grown to become his most successful project, taking him to some of the most prominent electronic music venues in the world.

When we met for the interview, Fernow was recovering from a cold he got following an eight-hour DJ set back-to-back with Ancient Methods in Tbilisi, a marathon that Fernow wasn't exactly accustomed to. (At one point, Ancient Methods told him he looked exhausted and that he should go home.) Just before that, he'd played live as Prurient, his longest-running project, where he spills out his soul through tortured screams and piercing high frequencies. It's not the kind of thing you'd usually see at a nightclub, but Fernow has a special way of bridging worlds.

These days, Fernow has Vatican Shadow for dance music, Prurient for noise and Rainforest Spiritual Enslavement for dark ambient, a project focused on artificial field recordings that has been exhibited as an installation at festivals and art galleries. He's also become aligned with the Canadian label Profound Lore, arguably the most adventurous and influential platform for underground extreme metal today.

Fernow has been connecting different realms since the beginning of his career in the mid-'90s. After rummaging through the archives of his label, Hospital Productions, which turned 20 in 2017, he found some forgotten early releases that resembled techno, and were even referred to as such in label flyers. As Fernow tells it, influences flowed freely back in the messy DIY days. No one really understood the implications of what they were doing or what others were doing around them.

Hospital Productions has been a driving force in American underground electronic music for the last two decades, releasing around 600 records, tapes and other projects in that time. The label is responsible for some of noise music's landmark releases, like Prurient's 2002 album The History Of AIDS. More recently, it's become a sanctum for dance music's darker personalities, signing records by Shifted, Phase Fatale, Ron Morelli and Silent Servant.

Fernow's fascination with techno is nothing new. Though he grew up as a metal head of sorts, he cites Richie Hawtin's FUSE album Dimension Intrusion as his all-time favourite, and he was a rave kid back in Wisconsin. He started to collect DJ mixtapes—his only exposure to recorded dance music at the time—and it was the makeshift nature of the Midwest rave scene that would come to influence the way he operated as a noise artist.

"This tape by DJ Anonymous was so profound to me because it had two cassettes taped together, back-to-back," he explained. "One side had an S&M picture of a man tied up, and the other side had a picture of a woman. One was jungle and one was gabber. And coming from the death metal world, there was a connection between this idea of making demos [on tape]. And it really made an impression about what could be done if you don't have the means—just do it. If you can't find a case to hold two tapes, just tape two cases together."

Death metal was also a key part of his connection to electronic music. In the '90s, many death metal bands started to work electronic passages into their albums, as eerie intros or interludes, which caught Fernow's ear.

"It was such a departure from the 'band world,'" he said, "Where everybody does everything—they all play their own instruments. There's a kind of a literalism that comes with rock music. Techno was the most mysterious thing to me, coming from death metal. I didn't know anything about the machines, about the gear—I still don't. Even the idea of playing records that someone else made, records that were designed to be mixed with other records—it was such a departure."

"I decided that there must be something more extreme than death metal," he continued. "We'd heard about industrial music, but the only thing you could really find at the time was dance industrial, like Swamp Terrorists. So there was this program called Scream Tracker 3, just a dot matrix program where you get sample banks and really rudimentary effects. We couldn't find anything that we thought industrial should sound like, so we were gonna try to make it. It was me and my buddy. His stuff became techno and mine became noise, but it started out as this slow kind of techno. The very first music I made was on that program. CD-Rs weren't domestic yet, so we were always trying to dub the tracks onto a tape deck, but it never sounded good. We eventually had the tracks transferred from a desktop computer to a CD-R machine, and it cost like $100 a disc."

After progressing into noise music, Fernow moved from Madison to New York and started to amass releases on Hospital Productions. He opened a storefront for the label, which became a gathering point for seedier parts of New York City's underground electronics scene.

Fernow began putting put out hundreds of records and established a confrontational and sometimes frightening live persona armed with nothing more than a microphone. A video of one performance, at an in-store in Lowell, Massachusetts in 2001, stands out. Fernow writhes in front of a rudimentary stack of speakers, screeching into a microphone with his back to the audience. Another video shows a shirtless Fernow in New Paltz, New York doing a more spirited version of the same performance, wringing out unholy feedback from the speakers before violently plunging his microphone into one as if he were trying to destroy it.

It was only after years of Prurient and countless other harsh noise aliases that Fernow reconnected with the dance music that excited him so much as a teenager.

"Jim Siegel, the shop manager at the time, was bringing Sandwell District stuff in, and I was like, 'What the fuck is this? This is so good!' I didn't realize it was Karl [O'Connor, AKA Regis]. I knew British Murder Boys, but I didn't know Regis's solo stuff. Just seeing the records, the aesthetic, and the titles most importantly. This is what I'd been missing all that time. I cannot emphasize the importance of what all those guys did. That was the doorway back in for me."

Fernow had already started to experiment with more straightforward electronic music on Bermuda Drain, released through the avant-garde metal label Hydra Head in 2011. The album had some of the clearest and most straightforward Prurient music yet, featuring discernible lyrics, melodies and plush synths—albeit delivered in angry screams with harsh distortion. It marked a sea change from shows like that in-store performance in Lowell. Around the same time, Fernow started a new project, Vatican Shadow, with a tape of lo-fi beats called Kneel Before Religious Icons, which was first released on Hospital Productions and later reissued by Type.

Kneel Before Religious Icons featured a stark, smiling portrait of Nidal Hasan, better known as the Fort Hood Shooter, a US military psychiatrist who shot up an army base in Texas in 2009. The titles were borrowed from newspapers and headlines, adding a menacing political tinge to Fernow's music. The tracks sounded like acid-eaten techno and industrial, with harsh, repetitive beats puncturing the spooky atmospheres Fernow had been exploring in his recent music.

Vatican Shadow wasn't necessarily meant to be anything more than a one-off experiment. Fernow had the idea for the project while reading a newspaper article about the Fort Hood shooting, and a squatter who was living in the basement of his shop aggressively quizzed Fernow about the facts around the story.

"Pointing to the shooter, he proceeded to tell me that it was CIA, they were trying to make Obama look bad because he had planned to stimulate the economy and get out of the recession by legalizing marijuana," Fernow said. "It kept going in that direction and I started thinking about these beliefs and how so much conspiracy stuff is about an inability to believe, a need to try and feel empowered by having 'the real story.'"

Fernow saw the early Vatican Shadow material as being more influenced by industrial music than techno. Its style came through an attempt to turn the lengthy compositions of Bermuda Drain into something more concise. He never thought about DJing or mixing records—he said he was listening to artists like Traversable Wormhole and Function "as music," at home, not for DJing purposes. He admits that most of the stuff he made early on sounded "like shit" on a big system. This was techno as creative exercise, not built for clubs.

Vatican Shadow became a serious endeavour following an interview with Blackest Ever Black founder Kiran Sande, when Sande was still an editor at FACT Magazine. After the interview, Sande asked Fernow about Vatican Shadow, and if he could release anything on his new label. Fernow was a fan of Raime and Regis, who appeared on Blackest Ever Black's first releases, and he jumped at the idea. He was booked to play his first-ever Vatican Shadow show alongside British Murder Boys for a Blackest Ever Black showcase in London. But he never got on the plane, succumbing to an old fear of flying that ties into his deeper struggles with anxiety and OCD.

"It took me a long time to realize that it's not necessarily about the result, but it's about the process," he said. "And I think that part of the deeper connection that I had to techno worked the same way—it was experiential, forcing you to be in the moment. There's kind of an irony to it in that. This unhealthy way of living, traveling and never sleeping and all this obvious stuff that every DJ is faced with. But when you actually get to the club, with all the elements in place you can transcend the root of the problem. I think that one of the big issues we're all facing is roots. There's this cliche—'what's the root of the problem?'—but real roots, like the roots of a tree, there's not just one. There's many."

Techno culture forced Fernow to deal with his problems head on. His new obsession took him through a turbulent period that started with closing the Hospital shop. He moved to Los Angeles, a city he ended up hating for its remoteness. LA was the opposite of everything he had liked about Manhattan, where he could travel on foot and bump into people and have forced interactions, a necessary evil for an otherwise natural loner. (Fernow never liked Brooklyn. It made him feel claustrophobic when the steep hills would block out the horizon in the distance.)

After LA, Fernow headed to Florence, where he had family and a good friend: Nico Vascellari, an Italian noise artist with whom Fernow had a deep connection. (Vascellari would later form Ninos Du Brasil, a techno group with industrial influences that would go on to release material through Hospital Productions.) He dealt with his fear of flying through frequent short flights in Europe. Fernow eventually moved to Berlin, a place where even a cynical person like him admits there's a sort of "magic." He signed to Berghain's Ostgut booking agency, which is one of the most credible positions any techno artist could find themselves in.

"One of the most amazing things about techno," he said, "is the whole art of the night. It's so different than playing in bands where everything is this pissing contest of competitiveness. I think one of the most amazing things I've learned is the idea of 'the night' that comes from having continuous music, when you have to consider what comes before you and what comes after you, acknowledge and respect the DJs before and after you, to give them space and to join them."

"It's so cool because it makes techno something that is real, something that's happening in the world," he adds. "The idea of going to a club and hearing the music and not listening to it at home gives it a real world value, it's experiential. It's something that has been totally destroyed in every other genre across the board, maybe with the exception of orchestral music. The idea of going to see a DJ with any number of pieces of big music being compiled, it's big-picture-thinking, musically—the idea that the club means something because you go there to hear the music done in a way that can't really be heard elsewhere. That's a connection to culture that's pretty much gone even from noise music."

The early Vatican Shadow performances were messy DIY affairs that reflected Fernow's background. I attended the first one, in Los Angeles, where Fernow stood behind a flight case and dropped a set of clanging, harsh rhythms to a confused audience. (He was opening for Demdike Stare.) A year later, I caught him at Electrowerkz in London, where his setup was laid bare—Fernow occasionally fiddled with two iPods playing backing tracks, while headbanging so violently it flung sweat into the audience. It was his take on a DJ set, something between noise and techno that made watching someone play music from iPods a visceral, captivating experience.

Fernow's dive into the world of dance music has made the Prurient project more focused, or at least, in his words, brought it "back to being extreme." Where Vatican Shadow is definitively techno, Prurient is open-ended, which is reflected in the project's 2015 double-album masterpiece, Frozen Niagara Falls, or the just-released Rainbow Mirror. The compartmentalisation allowed Fernow to reconnect with what he loved about the now-splintered noise music scene: the sense that anything was possible.

"The thing that was so cool about noise is that you would have a compilation with some obscure European industrial band and some guy making music with a bag of potato chips and it was just complete and total chaos," he explained. "And when we had the store, it was in an illegal space and I loved the absurdity of it. Selling tapes literally packaged in human shit, in Manhattan. We ended up disconnecting the phone, shuttering the windows, no posted hours—people didn't even know. The best thing that anybody ever said about the store was once they came in and said, 'Is this a store?' The idea that it was in Manhattan in the East Village was part of the concept, part of the sense of humour."

A sense of humour is important to Fernow, who has carried the ideals from the DIY noise scene with him so far that he doesn't take even the most serious of his projects too seriously. He has a way of making conversation that switches between grave statements and dark humour so quickly that you often can't tell when he's joking. This seeps into his work: Fernow pointed to the Vatican Shadow release Operation Neptune Spear, which features former Vice President Joe Biden talking about gay marriage under the name of the military operation to kill Bin Laden, as one example.

The other thing that has stayed with him is the idea that anything can be art or a performance. Fernow doesn't see a lot of the Hospital Productions releases as pieces of music necessarily—some were odd one-offs or spontaneous collaborations that were released just for the sake of being released, while others are meant more as artifacts than something to actually listen to. Hospital is more of an ongoing art project than a record label.

After a few drinks at that Russian bar, Fernow bemoaned websites like Discogs because they obsessively catalogue things, things that he thinks should be rightfully cast into the abyss of history. When I made an offhand comment about not knowing the whole his discography, he countered that "nobody should." He called his body of work "a stain on the world" in a loud tone of voice that, again, made it difficult to tell if he was joking or even exaggerating.

He also told me, in theatrically hushed tones as if it were a shameful secret, about a project made only in an edition of two—the kind of thing meant to be shown and sold in an art gallery instead of a record store. And then there's Rainbow Mirror, the seven-LP, three-hour Prurient album that came out in December, which he said is more about the process of recording. It's a piece about the long and droning process itself, rather than an album you're meant to listen to all the way through. It was inspired by the very first Prurient show, back in Madison, Wisconsin in 1997, when Fernow performed as part of a trio in a public park, siphoning electricity from the city.

"Rainbow Mirror is a concept piece, like, an environmental piece," he said. "The idea of a three-man station, where each guy has their own setup that's crude and primitive. Rudimentary electronics that sounded familiar, but put together in an uncomfortable way. I wanted to get back to a group idea, but with actual restraint, and limitations, in a way that has maybe come from techno. I wanted to reference the very first show and doing something live as a unit. The way it's put together in this unsequenced, raw, live uncontrolled way—sometimes there are surges in volume, and there's this tension. And the duration. If you did it for five minutes you wouldn't be able to perceive the mistakes, so the fact that it's kind of long and excessive and monotonous, uncomfortably so, is the only way that this process can be revealed. When I did this show 20 years ago, what made it good at all was that it was on the verge of failing.

"I've been really getting into the idea of durational recordings because it breaks and challenges the idea of an album, a collection, a world. When you present a listener with hours of music it can become environmental, you stop caring about it in a way, because you can't just absorb it one sitting, so you kind of go on living with your life and it becomes a different idea of what music can be. Drawing it out, forcing it to be experiential. You know, getting back into the techno thing, it's the same—so much about getting people together in a room and having an experience, or at least trying to."

The idea of the listener's experience is at the heart of nearly everything Fernow does. Whether he's divining screeching feedback from a speaker stack, soundtracking an immersive installation or turning a DJ set into a performance of heavy metal intensity, his work is united in the idea of a collective experience, which is probably why he connects with the dance floor so well.

"I wanna bring rock & roll to techno," he said. "It's about trying to find balance. I don't see [my music] as excessively dark—I just see it as noise and melody. Contradiction. It's self-awareness, self-criticism in order to overcome fear—it's all based around religion and fear. As a person with anxiety disorders... the part of your brain where your imagination lives is the part where anxiety lives. It's about projection—not being in the moment, not dealing with what's happening. That's the opposite of techno because you are forced to be in the moment, and that's the great thing about the club. It should be a fucking release, an alternate world where the simplicity of dancing and feeling the sound of the music, just being together in a room with people—but also being in your own space."

With Vatican Shadow, he's effectively traded dingy DIY spaces for dark basements and cavernous clubs without losing any of his confrontational power or uncomfortably intimate self-expression. His performances as Prurient and Vatican Shadow couldn't be any more different on the surface—one an anguished outpouring of personal grief and self-loathing, the other a relatively long and measured release of energy—but they're both about channeling the same thing. The steady thump of the kick drum over eight hours, and the trance it imposes, can be as cathartic as an hour of screaming your guts out.

"The bottom line in everything that I'm interested in musically is that it's a subculture," Fernow explained. "In another way it's folk music, which is the music of people's lives rather than, like, the background. The outcome doesn't matter to me—it's about the spirit. If the spirit of it is connected to lifestyle and decision-making, when it isn't just a form of entertainment but it's indicative of how you're living your life, that's what I identify with. That's what gives it value to me.

"I do think I have one of the strangest... for lack of a better word... careers. I'm not sure how many other people have played Coachella and then remixed Mortiis, and then we're sitting here in the Berghain office. It's incredible, but I do feel alone in some ways, like—what the fuck am I doing here?"