The early church categorised Psalm 6 as one of seven “Penitential” psalms, and sung it in worship on Ash Wednesday. Apart from the first verse it is not really a psalm of penitence, but a desperate cry for help, a prayer for healing in the midst of life-threatening illness. David’s illness has reduced him to weariness, perhaps even to a place where his prayer is no more than a moan accompanied by tears. Some might say it is not prayer at all; others would say it is the truest kind of prayer.
Kidner suggests a simple structure for the psalm which highlights David’s utter weariness:
a) Vv. 1-5 … 10 strophes, many petitions
b) V. 6a … the central strophe
c) Vv. 6b-10 … 10 strophes, no petitions.
The first verse may be interpreted in several ways. Perhaps David understands his sickness as sent by God, a direct result of God’s displeasure, and so pleads for God to relinquish his anger. Or perhaps he thinks that his illness is something allowed by God, and so pleads that God not be angry with him for requesting its removal. Either way he seeks a gracious rather than an angry God. This becomes explicit in verse two: Be gracious to me O Lord … Heal me, O Lord. Verses 2-3 speak of his bones and his soul being dismayed. It is perhaps better to think of this as two ways of saying “my whole being,” rather than a focus on inner being and outward being. To the very depths of his being, and in the totality of his being, David is greatly dismayed. Verses 4-5 show why: his illness has brought him to the brink of death, and so his cry is a desperate plea to God for rescue, for salvation, for deliverance.
But you, O Lord—how long? Return, O Lord! Jürgen Moltmann has rightly emphasised that suffering occurs on multiple levels: the physical suffering occasioned by illness, violence or oppression, and the spiritual suffering that arises from the sense that in our suffering, we have been abandoned by a God who does not care. David’s words are a plaintive cry that God “return.” He is convinced that God does indeed care, and appeals to his covenant love. Yet it is evident that he must pray day after day and night after night, drowning his couch with his tears: the answer has not come immediately.
But the answer does come at some point, according verses 8-10, where David’s desperate faith becomes defiant faith. His enemies, perhaps taking advantage of his illness, undermine his leadership and add to his grief. Has David been healed, or at least turned a corner so that he is on the road to recovery? It is impossible to know with any certainty. The past tenses in verses 8b-9a indicate that his confidence that his prayer is heard, but the future tenses in verse 10 suggest that he is still looking forward to recovery and vindication. The Lord has “returned” and so his enemies will be “turned back.” He is no longer dismayed, but his enemies will be dismayed. He may not yet have been healed, but his prayer has opened a vision of victory. This is not a manufactured confidence, but a confidence grounded in the covenant love of God and received in a prayer that persists in the face of doubt and anxiety, and waits for the light of hope.
There are two echoes of this psalm in the New Testament. First, in John 12:27 Jesus says, “Now my soul has become troubled; and what shall I say, ‘Father, save me from this hour?’ But for this purpose I came to this hour.” This appears to be an echo of verse 3-4, but whereas David cries to be saved from the hour of his death, Jesus accepts the prospect of impending death as the very purpose of his coming. Craigie rightly notes that we “perceive the pathos of the psalm most clearly when it is read in the context of the passion” (96).
For David, death meant the end of God’s gracious gift of life (verse 5). Those who go down into Sheol—a kind of underworld in Hebrew thought—have not ceased to exist, but their existence is shadowy and insubstantial. In Sheol, there is no remembrance of God, no thanks, no praise, no worship. Kidner’s discussion of Sheol is worth reproducing in full:
Sheol can be pictured in a number of ways: chiefly as a vast sepulchral cavern (cf. Ezk. 32:18-32) or stronghold (Pss. 9:13; 107:18; Mt. 16:18); but also as a dark wasteland (Jb. 10:22) or as a beast of prey (e.g. Is. 5:14; Jon. 2:2; Hab. 2:5). This is not definitive language, but poetic and evocative; and it is matched by various phrases that highlight the tragedy of death as that which silences a man’s worship (as here; cf. 30:9; 88:10f.; 115:17; Is. 38:18f.), shatters his plans (146:4), cuts him off from God and man (88:5; Ec. 2:16) and makes an end of him (39:13). These are cries from the heart, that life is all too short, and death implacable and decisive (39:12f.; 49:7ff.; cf. Jn 9:4; Heb. 9:27); they are not denials of God’s sovereignty beyond the grave, for in fact Sheol lies open before him (Pr. 15:11) and he is ‘there’ (Ps. 139:8). If he no longer ‘remembers’ the dead (88:5), it is not that he forgets as men forget, but that he brings to an end his saving interventions (88:12; for with God to remember is to act: cf. E.g. Gn. 8:1; 30:22)
(Kidner, Psalms 1-72 (TOTC), 61-62).
David cries out for deliverance from this devastating reality of Sheol; Jesus embraces it—and opens a way beyond it for those who come to him, and take up the way of the kingdom. At this point the second New Testament echo of this psalm becomes relevant. In Matthew 7:23 Jesus, echoing verse 8, says, “Depart from me, all you who do iniquity.” Jesus’ embrace of the cross and of death and hell opens up the promise and way of resurrection, a hope beyond the hopes of David. But it is a hope for those who cling to him and choose the way of the kingdom.
Thus this psalm speaks to us at several levels of meaning. First, as a psalm dealing with the pathos of sickness and mortality, it reminds us of the certainty of coming death, and the brevity and fragility of life. Given modern medical advances and western cultural mores, it is often difficult for us to enter into the depths of David’s dismay at illness and the prospect of death – the hope of resurrection to eternal life in the presence of God had not yet emerged in Hebrew thought. Yet, our culture clings to life and youth with a desperation that betrays our casual dismissal of this awful reality. The psalm also reminds us of the suffering of those who are ill, and calls us to compassion and prayer, that the sick are not left alone in their suffering. But, set within a broader biblical context, this psalm also preaches the gospel, that there is indeed hope and healing for those who trust in Christ.