The song was originally written for their breakthrough album Dirt, but was shelved at the time and used later for the Last Action Hero soundtrack. Contrary to popular belief, Jerry Cantrell did not use a traditional sitar during the recording session although he did attempt to play one but was unsure how. While experimenting with sounds, he adopted a guitar-sitar into the session to achieve the sound of the opening riff. In the liner notes of 1999's Music Bank box set collection, guitarist Jerry Cantrell said of the song:
This and "A Little Bitter" were mixed by Andy Wallace because Toby [Wright] had a previous commitment, and they always bothered me because they were too "tinny" compared to our other stuff. So I was happy to see Toby finish his work off with the remixes [on Music Bank]. That's not to disrespect Andy, it's just that he wasn't there when they were being created. Toby's like a brother, he knows all our shit, all our personalities and we don't trust anybody unless we've got something on them.
"What the Hell Have I" was a one track promotional CD shipped to radio stations only in 1993 in support of their appearance on the 1993 Lollapalooza tour. "What the Hell Have I" peaked at number 19 on the BillboardMainstream Rock Tracks rankings.
Allmusic's Jason Birchmeier said that the song is "on a par with those featured on the band's recent (and magnificent) Dirt album." Ned Raggett of Allmusic said that the song "isn't bad at all but on the flipside has little immediate surprise to offer to it."