Lyric discussion by dreamember 

Cover art for Anathema lyrics by Twenty One Pilots

A lot of Tyler's songs deal with sleep/night time like ode to sleep, guns for hands and truce. I think this song is about those nights where he has too many worries and thoughts that keep him up at night.

'You will never know what's behind my skull/You will never know what's under my hair/You will never know what's under my skin/You will never know what is in my veins' - I think this refers to how he is able to put on a facade during the day but when night comes he struggles to hide how he actually feels and deals with his anxieties and fears that he has avoided throughout the day.

'I'm calling my father, Am I screaming to an empty sky?' He doesn't know who to turn to when he feels this bad and questions his faith as he tries to reach out to God.

My Interpretation

Another thing that I forgot to add was the definition of the word Anathema which is a curse or something/someone that a person strongly dislikes. I'd say this song is more about these feelings he has being a curse.