Every night on her current tour, at the moment she emerges onstage as Lady Gaga, perched atop a 14-foot-high crimson gown, Stefani Germanotta starts to panic. At the center of her opera-house set, two layers of curtains part, revealing that glorious, preposterous, Clifford-size crinoline and the tiny woman ensconced within it. Twenty thousand or so now-grown Little Monsters scream for the guiding light who told them, when they needed it most, that they were born this way. They still need it.

High above the crowd, she’s lightheaded, too aware of a pounding heart. As the dress glides forward and her band crashes into the evening’s first chords, she braces herself against the adrenaline flood that once felt like her reason to live. “When I am not onstage, I feel dead,” she told me in our last encounter, 14 years and several mental-health crises ago, before she’d ever seen a therapist. “Whether that is healthy or not … is really of no concern to me.” She bragged back then of not sleeping or eating, of living on “coffee and music.” She was dating, on and off, a surly, metalhead bartender she considered her muse. Everyone around her called her Gaga.