The film employs methods of direct cinema, which emphasizes observation, limited stylization, and non-intervention by filmmakers.

Wiseman had previously produced The Cool World (1964), based on Warren Miller’s novel of the same name, an experience that informed his desire to direct.

[4] While on location, Wiseman recorded the sound and directed the cameraman — established ethnographic filmmaker John Marshall⁠ — via microphone or by hand.

[10] Wiseman appealed to the Massachusetts Supreme Judicial Court, which in 1969 allowed it to be shown only to doctors, lawyers, judges, health-care professionals, social workers, and students in these and related fields.

[9] Wiseman believes that the government of Massachusetts (concerned that the film portrayed a state institution in a bad light) intervened to protect its reputation.

The state intervened after a social worker in Minnesota wrote to Massachusetts governor John Volpe, expressing shock at a scene involving a naked man being taunted by a guard.

[7] The dispute was the first known instance of a film being banned from general American distribution for reasons other than obscenity, immorality, or national security.

Steven Schwartz represented one of the inmates, who was "restrained for 2½ months and given six psychiatric drugs at vastly unsafe levels—choked to death because he could not swallow his food.

[8] The state Supreme Court ordered that "A brief explanation shall be included in the film that changes and improvements have taken place at Massachusetts Correctional Institution Bridgewater since 1966.