The psalmist describes his illness as no soundness in my flesh and no health in my bones. Both flesh and bones denote the total being, the whole body. It is impossible to say with certainty what his disease was, if, in fact, the language describes an actual disease and is not simply conventional language in a lament of this kind to describe complete physical and emotional distress. Some commentators conjecture a skin disease, such as leprosy. In verse 3b health translates shalom (see comments on “peace” in 29.11).

The psalmist recognizes his illness as being due to Yahweh’s indignation and to his own sin; there is no contradiction here, since in the thinking of the psalmist God’s anger is caused by the sinning. The translator will notice that Good News Translation has placed the cause, “your anger,” before “great pain” in the first line, and placed the cause, “my sins,” after “diseased” in the second line. The translator should examine which set of relations is most natural in the receptor language, and which provides the reader with the best understanding and poetic effect. The Hebrew order is condition then cause in both lines.

In verse 4 the psalmist likens his sins to a flood which threatens to drown him (literally they have gone over my head), and to a burden too heavy for me. Good News Translation has taken my iniquities … over my head to be like a “flood.” If the translator adopts this possibility, very often some syntactic adjustments will be required; for example, “I am like a man drowning in a flood, my sins are so many” or “My sins are so many they are like a flood and I am drowning.” One may prefer to avoid the flood imagery and say, for example, “My sins pile up higher than my head”; see New Jerusalem Bible “My sins stand higher than my head.” The figure of a burden, or a load, is in many languages a natural one to use with sin or guilt, or with unwelcome responsibilities or activities.

Quoted with permission from Bratcher, Robert G. and Reyburn, William D. A Handbook on the Book of Psalms. (UBS Helps for Translators). New York: UBS, 1991. For this and other handbooks for translators see here .