Tchaikovsky's final symphony has fascinated generations of music lovers, amateur and specialist alike, since its first performance just over a century ago. Timothy L. Jackson explores sensitively and without prejudice the question of the Pathetique's program and its relation to Tchaikovsky's homosexuality and death. The book covers the work's conception, genesis, and reception, and presents an in-depth analysis of its remarkable formal structure. The reception chapter investigates the Pathetique's impact on Tchaikovsky's younger contemporaries, most notably Mahler and Rachmaninov, and on more recent Russian composers like Shostakovich and Schnittke. Also explored is the dark side of the symphony's political interpretation in the twentieth century, especially its transformation into a cultural icon of the Third Reich.