"Madhouse" was released as the only single and third track from the group's second full album, Spreading the Disease. The song is written in an up-tempo time signature, with heavy distorted guitar riffs. The song is about going insane.[2]
It has become a staple of live concerts, and has also appeared on Anthrax's "best of" album, Anthrology: No Hit Wonders (1985–1991). In 2009, the track was named the 46th best hard rock song of all time by VH1.