I've always thought this song was about someone who blames themselves for their loved one's suicide.
"Step one, you say, "We need to talk"/He walks, you say, "Sit down, it's just a talk"
Have you ever tried talking to someone about their health when they're obviously mentally ill? They don't want to talk about it. They just want to curl up in themselves, and whenever you confront them about their well-being, they try to walk away.
"Let him know that you know best/'cuz after all, you do know best"
They try to convince their loved one to get help, get better, etc. To me, this line always sounded a little sarcastic. Maybe they didn't know what was best, maybe their advice actually made their friend even more depressed, or, if they weren't already, suicidal.
"And I would have stayed up with you all night/had I known how to save a life"
If they had only known what their friend had been attempting, they would have stayed up and talked them out of it, or at least tried to. Instead, they either didn't know what was happening, or didn't know how to deal with it and let their friend slip away.
"As he begins to raise his voice/You lower yours and grant him one last choice"
The loved one gets angry and defensive, and an argument ensues. The two choices they give him--"driving until he loses the road" or "breaking the ones he's followed"--may have been taken wrong and the loved one was driven to suicide.
This is just is my take on it, but it's probably actually about drug use.
The Fray: How To Save A Life - Music Video
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