Lyrically, "Live to Tell" portrays the complexity of deceit and mistrust. The song is also about childhood scars and had an extreme emotional pitch. According to the book "The Heart of Rock & Soul" by Dave Marsh, the archetype of songs like "Live to Tell" is The Platters' song "The Great Pretender". In an interview about the song, Madonna said, "I thought about my relationship with my parents and the lying that went on. The song is about being strong, and questioning whether you can be that strong but ultimately surviving."