The Band were not in great shape when they started work on Stage Fright in the summer of 1970. They'd just finished up one of the greatest two-year runs in rock history, but fame was beginning to take its toll. Many members of the group were drinking very heavily and taking hard drugs, particularly keyboardist Richard Manuel; he was a hopeless alcoholic and was making it very difficult for the Band to carry on normally.
When Robbie Robertson wrote the lyrics for "The Shape I'm In," he was thinking about Manuel. "Out of nine lives, I spent seven," he wrote. "Now, how in the world do you get to heaven?" Appropriately, Manuel handled lead vocals on the track, though few people realized he was singing about his own demons.