What does Psalm 41:5 mean?

As a warrior and king, David had many enemies. His sin with Bathsheba (2 Samuel 12:7–9) provided enemies with opportunity for criticism and attack. It also led to a fractured family life (2 Samuel 12:10–11). That dynamic eventually pushed David's son, Absalom, to rebel against his father. This was aided by one of David's most trusted advisors, Ahithophel. While this psalm does not explicitly name the situation, context makes Absalom's rebellion the most likely inspiration (2 Samuel 15—18).

Those wanting to replace David as king would have wanted him to die. They would want his legacy erased. David began his psalm expressing confidence that God would protect the life and reputation of godly people (Psalm 41:1–3). In the case of Absalom's revolt, this was especially relevant. Absalom himself had no son (2 Samuel 18:18)—if he retained the throne, it would likely mean the end of David's line. Yet God had promised David's descendants would occupy the throne of Israel forever (2 Samuel 7:11–16). Ultimately, Jesus Christ, David's chief descendant, and heir to David's throne, will reign over Israel as her long-awaited king. In his salutation to Mary, the angel Gabriel announced, "And behold, you will conceive in your womb and bear a son, and you shall call his name Jesus. He will be great and will be called the Son of the Most High. And the Lord God will give to him the throne of his father David, and he will reign over the house of Jacob forever, and of his kingdom there will be no end" (Luke 1:31–33).

David admitted his sin (Psalm 41:4) and expected God to forgive and rescue him (Psalm 41:11–12). He anticipates that God can "heal" him of sin and preserve him from these attacking forces.