The succession of cult band shirts worn by Riz Ahmed for his Oscar-nominated leading role in Sound of Metal establish the insider credentials of the film as much as those of Ahmed’s character. One of them will provoke particularly unexpected nostalgia for underground punk fans: a white Rudimentary Peni T-shirt, emblazoned with the cover of the Hertfordshire trio’s 1988 album Cacophony.

Formed in 1980, Rudimentary Peni shuffled awkwardly at the edges of the anarcho-punk scene, their breathless pace and sheer oddity marking them as something else entirely. Though brilliant, they were far from natural performers, especially as vocalist Nick Blinko’s gargled falsetto-to-baritone screech was hard to recreate at full volume live.

The band last played a gig in 1993, so news of a new album this month came out of the blue, especially as it has been 26 years since their previous one. Blinko’s mental ill health has also compromised releases. “In depression, the work is total rubbish,” he says, speaking via email in a rare interview. “No ideas, no drive.” Fans at least have had time to study Blinko’s highly intricate and often disturbing drawings of decapitated priests, giant foetuses and numerous coffins on those early foldout sleeves.

“I really admired Rudimentary Peni,” says producer Steve Albini on discovering them in the early 80s. “They exhibited a kind of mania that personalised their music, like nobody else could make it. All my favourite music sounds like that, like there’s only one way to get to it, through a kind of obsession.”

Cacophony is now seen as an underground classic, as is their 1983 anarcho-punk debut Death Church, and two preceding seven-inch releases which crammed in 12 and 11 tracks respectively. Their ferocity and brevity broke ground for many heavier grindcore bands such as Napalm Death, and made a fan of Albini. “Very few bands, Rudimentary Peni being one of them, kept the perverse and personal quality of punk music intact while evolving musically,” he says.

Cacophony, a concept album about horror author HP Lovecraft, came after a five-year hiatus following Death Church, which had spent weeks near the top of the UK indie chart. Cacophony’s tracks contained a smattering of songs about the band’s core topics of death, clergy and dysfunctional family, but most of the material was about Lovecraft, from his roster of monstrous beings to stories of his writing career.

Blinko doesn’t think the connection sold Rudimentary Peni to Lovecraft enthusiasts, however. “The studiers of Lovecraft prefer slender connections,” he says airily, citing Chicago psych-rockers HP Lovecraft, “not a Lovecraftian cacophony with analysis of quotes.”

As a simple punk album, it was a mess. But those who risked a second listen were rewarded with a counterintuitively cohesive mix of punk, thrash, deathrock, gothic dirge and even something akin to modern classical played through overloaded amplifiers (there is a nod to composer Michael Nyman, meeting a pie-man in a rhyming couplet).

Their next album, 1995’s Pope Adrian 37th Psychristiatric, was largely written in a period when Blinko was hospitalised with severe delusion. He believed he was Nicholas Breakspear, AKA Pope Adrian IV, the only English pope, who reigned between 1154 and 1159 – he and Blinko share the same initials and place of birth, the village of Abbots Langley. The refrain “Papas Adrianus” is repeated from the beginning to end of the album.

Blinko was eventually diagnosed with schizoaffective disorder, the effects of which he details – along with his treatments, including electroconvulsive therapy – in his semi-autobiographical 1995 novel The Primal Screamer.

“I was depressed and attempted suicide at 18, and I saw precursors to those feelings up to that point,” he says. “Then, at about 26, I had a psychotic breakdown. Depression was a more obvious diagnosis – schizoaffective disorder took much longer. At times I had a kind of acute anxiety and couldn’t even think of explaining it, exacerbating the situation more.”

This diagnosis, along with his self-taught and obsessive drawing style, saw Blinko labelled as an “outsider artist”, a sometimes restricting framework given to artists with mental health difficulties or unusual lifestyles. Blinko’s work is remarkable on its own terms, the often-crowded, grotesque scenes with minute detail as likely to be filled with skulls as they are microscopic repeated texts.

The outsider art label has, at least, made his remarkable work desirable and marketable in the art world, with some of his drawings collected in the renowned Collection de l’Art Brut in Lausanne, and others sold at Sotheby’s. Blinko says issues with both health and medication have impacted his ability to work on this art and his music. As well as depression numbing his creativity, when he is in a manic state, he says, “work is utterly profound, but not for long”.

The new album Great War naturally features Blinko’s cover art, and takes its lyrics from the war poetry of Wilfred Owen. It opens with one of bass player Grant Matthews’ unmistakably foreboding intros, before caustic guitar kicks in over Blinko’s plaintive recital of Anthem for Doomed Youth: one minute and 57 seconds of anger that sets the lo-fi, near-black metal tone for the rest.

“I felt World War I was sadly perfect for what we do,” says Blinko. “Some [of the album] even sounds like it. It’s long been deeply associated with madness.” Whether composed amid mania or not, it is utterly profound. The artwork looks great on a T-shirt, too.

• Great War by Rudimentary Peni is released 23 April on Sealed Records

• In the UK and Irish Republic, Samaritans can be contacted on 116 123 or email jo@samaritans.org.

• In the US the National Suicide Prevention Lifeline is 1-800-273-8255.

• In Australia the crisis support service Lifeline is 13 11 14.

• Other international suicide helplines can be found at www.befrienders.org