As the fourth Joker's Card in the group's Dark Carnival mythology, the album's lyrics focus on the titular Great Milenko, who is a necromancer.

Although the album was poorly received by critics, it debuted at number 63 on the Billboard charts, and was later certified platinum by the Recording Industry Association of America (RIAA).

Following the 1994 release of the album Ringmaster, Insane Clown Posse started to attract a strong local following in Detroit, Michigan.

[8] The group started recording The Great Milenko in 1996, and Violent J began thinking of a title for the album shortly after.

[9] Believing that he had created the name himself, Bruce later realized that he had unwittingly used the nickname of Dean's father, Boris "The Great" Malenko.

[10] Julian Raymond, the artists and repertoire representative for Hollywood Records, contacted Slash, Steve Jones, and Alice Cooper.

[10] Slash, who was a self-professed fan of the band's music, reportedly only asked for Wild Irish Rose as payment for his contributions.

[13] Bruce and Clark also met George Clinton, who was staying in the same hotel, and recorded his voice in his room, but it did not fit anywhere on the album.

[15] Disney requested that the tracks "The Neden Game", "Under the Moon", and "Boogie Woogie Wu" be removed because of lyrics referencing abuse of women, rape and murder, and the slaughter of children, respectively.

[17] The Great Milenko is the fourth Joker's Card in Insane Clown Posse's Dark Carnival concept album series.

[18] The Dark Carnival is a concept of the afterlife in which souls are sent to a form of limbo while waiting to be sent to heaven or hell based on their individual actions.

Each of the six Joker's Cards relate to a specific character—an entity of the Dark Carnival—that tries to "save the human soul" by showing the wickedness inside of one's self.

[21][22] The Card ultimately issues a warning against such acts of sin, and enlightens listeners that The Great Milenko is a part of every individual, and that they have the power to fall under his illusions or cast his hoaxes aside.

[21] Stephen Thomas Erlewine of AllMusic wrote, in his review of The Amazing Jeckel Brothers (1999) that, "The Great Milenko [...] was targeted at white-boy, adolescent metalheads -- really, how could any album that contained guest spots from Alice Cooper, Slash, Steve Jones and Legs Diamond be anything else?

The "Neden Game" takes the form of a Dating Game-esque show, albeit with added misogynistic banter for humor.

[3] During a music-store autograph signing, Insane Clown Posse was notified that Hollywood Records had deleted the album within hours of its release,[15] despite having sold 18,000 copies and reaching number 63 on the Billboard 200.

[34] Entertainment Weekly music critic David Browne gave the record a C-minus rating: "[With] its puerile humor and intentionally ugly metal-rap tunes, the album feels oddly dated.

"[3] AllMusic reviewer Stephen Thomas Erlewine said that The Great Milenko is "the sort of record you wish they would take off the stereo at excruciating frat parties.

Stephen Thomas Erlewine said that the album was "a better record than [its] predecessors, boasting a tougher sound and some actual hooks, without losing the juvenile vulgarity that pleased their following", and added that "it is better than the rest of ICP's work".

[35] David Browne said that "Milenko is better produced than the duo's earlier output (Slash grinds out metal chords on Halls of Illusions), and Pass Me By is a genuinely melodic song.