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I'm all mashed up inside.

Inside the Lost (TV series) a guy named Boone who got desperately injured imparted his physical situation to the doctor with the above sentence. The guy prefers to die, and tries to let the doctor off the hook.

Does it specifically refer to a special physical situation? or it generally means suffering severe injuries? Does it have mental connotations?

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"Mashed up inside" isn't a medical term and so doesn't refer to a specific injury to a specific organ. He is saying that he feels he has has multiple severe internal injuries. He is much more likely to be referring to physical rather than mental injuries.

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