The album marks the return of guitarist Paul Allender to the band, as well as the introduction of drummer Adrian Erlandsson (At the Gates, The Haunted) and keyboard player Martin Powell (My Dying Bride, Anathema).

Dani Filth explained to the magazine Empire in September 2012: We loved Cabal, The Damnation Game and The Books of Blood, and we liked that everything had "Clive Barker presents..." on it before people even knew who he was.

The central song, "Tortured Soul Asylum", is about Midian, and the characters in the rest [of the album] made up a sort of collective from this mythical place where the monsters live.

In the Bible, the "Midianites" are an Arab tribe descended from Abraham, and Midian itself is where Moses spent his forty-year exile from Egypt.

The Midian of Cabal and Nightbreed is a hidden city west of Calgary in Alberta, Canada, offering shelter for monsters away from humanity.