This song finds a man (apparently schizophrenic) being confronted by his dark side, who warns him that he cannot be repressed much longer. When this sinister side shows up, the man wakes up with blood stains on his hands, wondering what he did.
Dave Mustaine has said that the song is about himself, and that he wrote it after "it was pointed out to me that I'm kind of schizophrenic and that I live inside my head." He revealed on VH1's That Metal Show, however, that the song was inspired by a friend of his girlfriend (and later, his wife), Pam. This friend suffered from anxiety attacks - Mustaine called her "s--thouse crazy." She would take Pam to a party, have an anxiety spell and leave her; Mustaine would get the call and have to pick her up. After Mustaine wrote this song, Pam thought it was about her, but Dave assured her she was "not that crazy." Said Mustaine, "I wrote this song about her nutty friend."
Dimebag Darrell of Pantera loved this song and got a tattoo of a black tooth grin after a tour, a reference to the line, in this song, "Someday you too will know my pain and smile its black tooth grin." Darrell also created a drink he named after the song, which is mostly whiskey with a splash of Coke. Regarding the line, Dave Mustaine told Billboard: "I think there's no better description of the joy of a good fight than when you see a boxer who's smiling after he's won, but he's had a tooth knocked out."
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