In Howl, madness is relative. In fact, this poem turns our common notions of sanity on their head. People society typically sees as perfectly normal, the speaker considers insane. People that society generally sees as mentally ill, the speaker considers misunderstood geniuses. Ginsberg spent eight months in the Columbia Presbyterian Psychiatric Hospital, where he met Carl Solomon, to whom the poem is dedicated. He thought Solomon was a talented artist whose gifts were stifled by the oppressive psychiatric treatment he received. The poem treats hospitals and doctors with suspicion, while visions and hallucinations are signs of a divine connection. One of the most memorable experiences of Ginsberg's life was a vision in which William Blake read his poetry aloud. However, the line between inspired madness, genuine madness, and drug-induced madness is extremely blurry in this poem.
The poem argues that Carl Solomon is in fact mentally ill and needs psychiatric help. The speaker blames social institutions represented by "Moloch" for his friend's sad situation.