Like Erwartung, composed a year earlier, it was heavily influenced by Otto Weininger's book Sex and Character.

The underlying message of the piece is the idea that man continues to repeatedly make the same mistakes, and the plot is developed from events in Schoenberg's personal life.

[2] The drama represents an inescapable cycle of man's plight as it starts and finishes with the male character struggling with the monster on his back.

The score calls for: piccolo, three flutes (3rd doubling on 2nd piccolo), three oboes, English horn, D clarinet, three clarinets (in B-flat and A), bass clarinet, three bassoons, contrabassoon, four horns, three trumpets, four trombones, bass tuba, timpani, cymbals, bass drum, snare drum, tamtam, high and low bells, triangle, xylophone, glockenspiel, metal tubes, tambourine, hammer, harp, celesta, and strings.

The piece also employs an offstage ensemble consisting of piccolo, E-flat clarinet, horn, trumpet, 3 trombones, triangle and cymbals.