"Extreme Occident" finds Madonna trying to discover her place in this world:
I was right, and I've got the right
To choose my own life like a full circle
The singer has been defiant all her life, unwilling to bend to the way society tries to mold her.
Madonna sings on the chorus:
I guess I'm lost
I paid the handsome cost
The thing that hurt the most
Was that I wasn't lost
Speaking to iHeartRadio's 103.5 KTU hosts Cubby and Christine, Madonna admitted the lyric sounds like a nonsense "riddle." The singer explained she is talking about how she used to beat herself up over the criticism of naysayers. Madonna added that it hurts her to think "I wasted all that time caring what people think."
Madonna expanded on the lyric during an interview with Mojo: "I'm saying that I'd been told I was lost, that I was confused and I didn't really know what I was talking about. I paid for the things I said and did and spoke out against or fought for, and I listened to too many people telling me that I was wrong or that I should be quiet, that should go away or that I didn't know what I was talking about, or that I was making the wrong decisions. Too many voices of too many people convincing me that was 'lost'. And then I realized I wasn't. So that hurt because I realized I had wasted so much energy beating up on myself for no reason when I should have just listened to my voice and believed in myself."
The Queen of Pop added that it was a slow-dawning realization, which took her many years to grasp.
Madam X was written by Madonna after she moved to Lisbon, Portugal; the relocation was because of her son David being signed by the city's football team.
"Extreme Occident" was the second song that Madonna wrote for Madame X. It is influenced by morna, the national music of the Portuguese-speaking island country of Cape Verde. Madonna told Cubby and Christine its sound is "indicative and reflective" of her time in Lisbon.