Beyond severe physical pain, one of the deepest tragedies of human suffering is social isolation and the loss of support from close family and friends. Extreme hardship has a way of severing a person even from their most intimate circles. Commentators offer several reasons for this forced social detachment. Some explain that the rejection is practical, driven by extreme poverty and a severe skin disease that physically keeps people away [ביאור שטיינזלץ]. Others view the cause as reputational, noting that his massive suffering leads relatives to assume he is a terrible sinner receiving punishment for his wrongs [מצודת דוד]. Additionally, another perspective suggests that negative spiritual forces of anger and impurity surround his home, creating an atmosphere of terror that frightens people from approaching [מלבי״ם, אלשיך].
This intense loneliness is deeply painful because it robs him of the basic comfort he might have found within his own household. Instead of offering a moment of peace, their withdrawal only multiplies his troubles and deepens his feelings of rejection [חומת אנך].
The isolation affects two distinct groups: closest family members, and old acquaintances who knew him in better times. The primary approach among commentators is that these former acquaintances have become completely alienated, treating him like an absolute stranger [מצודת דוד, מצודת ציון, רלב״ג, ביאור שטיינזלץ]. However, another perspective suggests that they did not merely become strangers, but actually treated him with active cruelty [רש״י, ביאור שטיינזלץ].
An interesting distinction exists between how the family members and the acquaintances are affected. While the closest relatives are entirely removed from his life, the acquaintances are only partially distanced. This difference occurs because the negative forces keeping people away focus their energy on destroying the strong, natural family bond, which had the true potential to bring him comfort. They do not invest as much effort in driving away casual acquaintances, since their presence would not have offered much meaningful help anyway [אלשיך].