Beginning in 2008, The High End of Low era began with the return of Twiggy Ramirez to the band and followed the crumbling relationship Manson had with actress Evan Rachel Wood, and his ensuing identity issues. The album dealt with the themes of politics, love, death, pain, film, rebirth, and self-realization. The track listing of the album is arranged in order the songs were recorded, making the album a journal of sorts, chronicling the personal life of the struggling front man.

It was during this era that Manson had dropped his label of sixteen years, Interscope Records, and became engaged to Evan Rachel Wood, despite prior relationship problems.