In this song, Joel talks about a guy who is struggling to cope with the pressures of his life. The song is unusual because it is sung in the second person (Joel referring to the character as "you") and is a rock song with very little guitar. The driving synthesizer implies the near-paranoia the man is feeling.
The video for this song was Joel's first concept video. It was directed by Russell Mulcahy, who also made the video for "Allentown." Joel wasn't a fan of music videos and had little interest in making them, so he let Mulcahy have his way with the clip. When Russell had him sink into foam and scream at the sky, Joel went along with it even though he had no idea what was going on.
When Joel sings, "All your life is Channel 13, Sesame Street," he's referring to the New York TV station WNET (channel 13), which is the PBS affiliate that carried the show. Joel later appeared on Sesame Street, singing "Just The Way You Are" with Marlee Matlin in a 1988 episode.
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