The episode’s title is a multi-layered descriptor of its various storylines:

Lou’s mental state is rapidly deteriorating. Haunted by visions of Brady, her "madness" is literal and debilitating. The judge’s decision to send her to a mental health facility rather than grant a plea deal underscores the tragic irony of her situation; she stopped a monster only to be consumed by his memory.

Morris represents a different kind of madness—the obsessive, entitled mania of a fan who believes an artist’s work belongs to him. His alliance with the manipulative Alma Lane (played by Kate Mulgrew) adds a grotesque, almost Shakespearean layer to the theft of John Rothstein's manuscripts.