The song centres on the main character, Pink (based on Roger Waters), who having lived a life filled with emotional trauma and substance abuse has reached a critical psychological break.
This means that Pink has committed a crime against himself by attempting to interact with his fellow human beings, defying the mission towards self-isolation that defined much of his life.
Through the course of the song, he is confronted by the primary influences of his life (who have been introduced over the course of the album): an abusive schoolmaster, his wife, and his overprotective mother; in the animated sequence, they are depicted as grotesque caricatures.
A prosecutor conducts the early portions, which consist of the antagonists explaining their actions, intercut with Pink's refrains "Crazy/Toys in the attic, I am crazy/Truly gone fishing" and "Crazy/Over the rainbow, I am crazy/Bars in the window".
It was then used again in the 2010-13 touring concert version, albeit with the "crazy" interludes modified to incorporate CGI (most prominently the replacement of the floating leaf sequence with one of a deformed humanoid lashing out towards the audience, surrounded by graffiti of hateful messages).
In the last verse (The Judge's verdict), a distorted electric guitar enters, playing a leitmotif from the album, a melody first heard in "Another Brick in the Wall" (and most recently reprised in the outro to "Waiting for the Worms").