Deep emotional pain rarely remains confined to the mind; it often spills over into the physical body, consuming a person from the inside out. Extreme sadness and worry can physically weaken an individual, draining their strength and drastically altering their appearance. The primary approach among commentators is that this state reflects severe weight loss and physical shrinking brought on by relentless worry and crying. The sheer force and power of a person's screams and sighs burn away their body fat, leaving their bones protruding and clinging to their outer frame [אבן עזרא, מצודת דוד, ביאור שטיינזלץ]. The sound of this suffering is not merely noise, but a display of intense, destructive physical energy [אבן עזרא, המאירי].
Commentators offer different perspectives on exactly how this physical deterioration takes shape. One approach explains that the bones cling to the skin. Unlike animals, human skin is tightly bound to the tissue beneath it, making them difficult to separate. As a result of severe emaciation, the bones press outward and stick directly to this outer layer [רד״ק, המאירי].
Conversely, another perspective suggests the physical toll affects the internal organs, particularly the intestines. The force of heavy sighing causes the intestines to press against the bones, effectively shutting down the body's ability to digest food. This internal physical collapse also serves as a powerful metaphor for the nation's fragile and shattered condition during times of religious persecution and destruction [מלבי״ם].
A unique interpretation draws upon the anatomical laws of kosher animal inspection. According to this view, a massive, forceful sigh travels up from the lungs and through the windpipe, causing the lungs to swell, rupture, and fuse directly to the rib bones. In these anatomical laws, a lung that adheres to the bone without any cushioning tissue is considered a fatal, incurable injury. This imagery illustrates a terminal, irreversible brokenness from which there is no hope of recovery [אלשיך].