In a March 2005 interview with Kitchen Sink magazine prior to the album's release, singer Mark E. Smith mentioned Heads Are Rolling and If You Assume as two possible titles.

", a song written from the point of view of an East German immigrant who berates Harold Shipman for giving morphine to old ladies instead of him.

The album's closing track, "Trust in Me", features guest lead vocals from Kenny Cummings of the band Shelby, who had first met Smith and Elena Poulou at the Gigantic offices earlier on the day it was recorded, with additional vocal contributions from Phil Schuster of Shelby, and recording engineers Billy Pavone and Simon "Ding" Archer.

[15] AllMusic's David Jeffries gave it 3.5 stars, describing it as "a rocking album that relies heavily on its highlights", which he considered to be "Pacifying Joint", "What About Us", "Blindness", and their cover of "I Can Hear the Grass Grow".

[8] BBC reviewer Nick Reynolds viewed Smith's performances on the album as erratic, stating "Sometimes he's as sharp as a needle, sometimes he's incomprehensible.