The song is presumably about a man who is trapped in a "sanitarium", which in this song is described as a mental asylum. He dreams of breaking free, and later in the song, there seems to be a mutiny of some sort in which the people trapped in the sanitarium rebel against the officials of the sanitarium, and James says he has "got some death to do" and that it "seems the only way of breaking free", probably implying that he is likely to kill the officials and break free.