If you were born with retardation or a deformity in the 19th century and early part of the 20th century, you ended up either as the sideshow in a circus or in a state institution which functioned as either a prison, work camp or warehouse, depending upon the degree of your developmental disability. Old Pinhead is the story of a young man born with moderate microcephalia whose mother would not commit him to an institution at the cost of her marriage. After her death he was committed to a place called The Cascade Custodial School For the Retarded. This is the chronicle of his five year plan and efforts to escape from the institution and live life as a free man.