The flag on the album’s cover is a signal flag for the letter “O (Oscar).” Signal flags represent individual letters of the alphabet, for ships to signal to one another. The “O” flag also stands for “Man Overboard.” The themes of the album include depression, the struggle of finding meaningful work, addiction, and imprisonment. In his Rolling Stone review, Stephen Holden suggests that “What we’ve got here is as evocative an exploration of one strain of the American character — the Puritan sensibility under extreme stress — as pop music has yet offered.”