High stakes discourse (HSD) is defined as any linguistic exchange where shared understanding is essential to the life, health, and/or valued property of at least one of the interlocutors, or of other human beings. Exchanges between air traffic controllers and pilots, doctors and patients, and consumers and pharmacists are HSD contexts. The purpose of this paper is to demonstrate theoretically and empirically that in general, HSD demands high-level general and specific language proficiency. The commonly claimed distinctness of language for general purposes (LGP) as contrasted with language for specific purposes (LSP) evaporates in HSD. Real-life contexts are discussed in light of research and current theory. Second language users must perform at the level of well-informed native speakers in HSD contexts. The grounded logic of true narrative representations (TNR-theory) shows why access to target language forms mapped onto authentic event sequences in films, dramas, and/or real-life contexts are essential to instill the proficiency needed in HSD.