Recording sessions overall lasted for a month. Machine then mixed the recordings with Nygard serving as Pro Tools operator. Dan Nigro of As Tall as Lions offered guest vocals on "Composing". Composition and lyrics Music and plot Musically, the sound of the album has been described as emo and pop rock, with elements of progressive rock, post-hardcore and dream pop. The concept album's story begins with the protagonist known as The Patient, who kills his wife while having a nightmare. Punknews.org staff member Brian Shultz wrote that The Patient then "seeks to create the song stuck in his mind created by medication, prescribed in the first place to fill the 'holes' and imminent loneliness following the murder". Julie Seabaugh of Riverfront Times said it stars a "guilt-stricken doctor, the newly convicted mental patient and the relentless songs in the patient's head alternately advance the plot from hospitals to halfway houses". The Patient is placed in a mental institution for rehabilitation, later being allowed to leave and tries surgery at home where he cuts his hands off. The Patient's frustration is fuelled by the self-inflicted loss of his hands, which Davis said related to the band "wanting to do something, but having never really written any form of real music before, and never being happy with anything we've done". The Patient ends up in various hospitals before succumbing to drug addition. He starts to become delusion and obsessive with creating music and murdering people. Davies says "the only way he can [convey the song in his head] is by killing people. And it just spirals down a dark and awful descent of this character". Lovat-Fraser said the album ended up "a lot more personal than I meant it to be. There's a lot of me on it. The Patient definitely has a manipulative side". Dupuy plays the deceased wife, "whose ghostly wail methodically crawls up all vertebrae as the most grisly case details are uncovered", according to Seabaugh. All of the songs use one-word titles, in contrast to the long titles of their previous album. The album opens and closes with two songs, namely, "Introducing" and "Dying", that feature spoken-word portions from Ken Greenberg. Now writer Evan Davies said this narration gave the "whole package a kinda conceptual mental illness/murder vibe". Tracks Shultz said in "Introducing", a character called The Doctor is "recording notes about The Patient following one of a