Past research shows that physicians experience high ill-being  but also high well-being .To shed light on how medical faculty’s experiences of their job demands and job resources might differentially affect their ill-being and their well-being with special attention to the role that the work-life interface plays in these processes.Qualitative thematic analysis was used to analyze interviews from 30 medical faculty  at a top research hospital in Canada.Medical faculty’s experiences of work-life conflict were severe. Faculty’s job demands had coalescing  effects on their stress, work-life conflict, and exhaustion. Although supportive job resources  helped to mitigate the negative effects of job demands, stimulating job resources  contributed to greater work-life conflict, stress, and exhaustion. Thus, for these medical faculty job resources play a dual-role for work-life conflict. Moreover, although faculty experienced high emotional exhaustion, they did not experience the other components of burnout . Some faculty engaged in cognitive reappraisal strategies to mitigate their experiences of work-life conflict and its harmful consequences.This study suggests that the precise nature and effects of job demands and job resources may be more complex than current research suggests. Hospital leadership should work to lessen unnecessary job demands, increase supportive job resources, recognize all aspects of job performance, and, given faculty’s high levels of work engagement, encourage a climate that fosters work-life balance. A growing concern for healthcare professionals and the general public is physicians’ ill-being, that is their impaired psychological adjustment, coping, and functioning , exempliDespite such struggles with ill-being, physicians also report high well-being, which involves positive evaluations and reactions in daily life , such asWork-life conflict, a form of role conflict, is the struggle that occurs between incompatible demands or pressures from people’s work and non-work life . AccordiThe high levels of work-life conflict experienced by physicians may exacerbate ill-being, given its many negative personal and job-related consequences. The more physicians experience work-life conflict, the lower their quality of life , and theAccording to the multidimensional theory of burnout , burnoutThe job demands-resources model  providesThe more people experience job demands, such as longer work hours, greater job insecurity, time pressure, work overload, or emotional demands, the more work-life conflict they experience ; this isPhysicians are also embedded in a culture that normalizes high demands, long hours, going above and beyond for patients, and being selfless and self-sacrificing , 2013. TGreater job demands can lead people to experience greater work-life conflict , which cHaving greater job resources  has been found to reduce work-life conflict, perhaps because they help employees complete their work responsibilities, thus lessoning spillover of work to their home domain . For insgreater work-life conflict through the process of engagement. Having greater job resources intrinsically motivates  that contribute to improved functioning in another domain . GreaterThe current study examines medical faculty’s experiences of well-being  and ill-being . Although all physicians experience threats to their well-being due to high workload, cultural expectations, work-life conflict, and more, we studied medical faculty because they may have particular challenges to explore, given that they hold multiple roles , necessitating that they be “quadruple threats” in their work , p. 4, aOur study examined four novel research questions:(1)Given their work context, how do medical faculty perceive, experience, and make sense of their (a) work-life conflict, and (b) work-life facilitation?(2)What are the consequences of work-life conflict for medical faculty and their family members?(3)How do medical faculty’s job demands affect their work-life conflict?(4)How do medical faculty’s job resources positively affect their (a) work-life facilitation, and (b) do they positively and/or negatively affect their work-life conflict?The sample consists of medical faculty from the largest department of one of the top research hospitals in Canada, which is consistently ranked in the top three of its kind worldwide. Thirty medical faculty participated in this study (19 women and 11 men). Faculty’s average tenure in the hospital was 13.36 years, and all held faculty positions at a prestigious university. Sixty percent reported being married or having a spouse. Participants had between zero and six children and eight faculty (26.7%) had a child younger than 6 years old. We purposefully sampled both leaders and non-leaders, men and women, and those with different job profiles to obtain as diverse a range of experiences as possible. See The interview guide was developed by drawing on previous research and theory, such as the job demands-resources model , role thThe interview guide began with general questions , then narrowed to more specific topics such as job demands, job resources, stress, and the work-life interface . It also included follow-up or probing questions. Each interview followed the interview guide; however, when new areas of interest emerged from participants’ responses, new interview questions or probes were devised , and the interview guide was amended. See The study received formal ethical approval from both the hospital’s and R.L.’s institutional research ethics boards. Faculty were invited through email to voluntarily participate in a study examining their stress and work-life conflict to inform the hospital about faculty wellness. Individual interviews were conducted by V.G. in the privacy of faculty’s offices at the hospital. Participants were introduced to the study, assured confidentiality of their responses, and asked to sign the consent form. The audio-taped interviews ranged from 40 to 60 min and were transcribed verbatim.Twenty interviews were conducted with preliminary analyses (open coding) occurring in tandem with data collection. Following this initial data collection, researchers paused to discuss findings, and it was determined that, because we were still establishing new codes, saturation had not been met. Another recruitment email was sent to the same department of medical faculty. Ten more interviews were conducted, until saturation was met.Following completion of the interviews and preliminary analyses, six feedback sessions were conducted with 13 participants to garner their responses to our initial findings. Overall, faculty reported that the findings were consistent with their experiences but wanted to reiterate or expand on some key points, such as the hospital culture, and the perceived valuing of research over clinical work. Their feedback may have made these issues more salient during the data analysis and theme creation process.a priori, using previous literature, theory, and research questions as guides . Drawing from previously established theories and models may have led to confirmation bias in the data analysis. However, we purposefully engaged in discussions about what participants said that was divergent and unexpected from these theoretical perspectives. We also deliberately explored variation among participants in their reported experiences.Given their work context, how do medical faculty perceive, experience, and make sense of their (a) work-life conflict, and (b) work-life facilitation?Theme: Experience of high levels of work interfering with non-work lifeMany faculty reported struggling tremendously with integrating their work and home lives and described high work-life conflict. One faculty said, “I think people talk about work-life balance and most of us don’t have……there is no balance, it’s just all work. I kind of am working 100% of the time, even if I’m not working, I’m working…I do feel like I have to spend all day Saturday and all day Sunday working and every evening because of the things I have taken on that have to get done. But that in turn leads to, you know, less social interactions, less interpersonal pleasures, less possibility to do other things.” Faculty were much more likely to experience work interfering with their non-work life than vice versa. When discussing family needs, one faculty shared, “I never let it interfere [with work]. My family was on the block, they always paid the price.” Prioritization of work over home appears to reflect that home boundaries are more permeable than work boundaries, thus, it is easier to have work eat into home time than vice versa . Indeed,Theme: Experience of low levels of work-life conflictIn contrast, a few faculty explicitly reported lower levels of work-life conflict, stating that they only experience their work encroaching on their home life “sometimes,” such as when they are on call or because they have fewer at-home responsibilities. For instance, one interviewee said that managing work and home life is “just a matter of organizing” and moving schedules around, while another reported that, as a result of her children being older, she was able to fully throw herself back into her work.It appears that some faculty attempt to manage their experiences of work-life conflict by engaging in cognitive reappraisals that facilitate the reinterpretation of situations to change their emotional impact . Some ofTheme: Vague experience of work-life facilitationWhen asked if their work and non-work lives had any positive effects on each other, faculty mostly provided responses that were vague, short, non-illustrative, and containing wishful platitudes. One faculty responded, “you hope that you get satisfaction in both and so they would feed positively into each other,” while another said, “people that are happy at home and their home lives I think are happy at work, they’re better workers, right? I think it has to be in that direction.” Typically, work-life facilitation was not a well-articulated phenomenon, especially in comparison with the vivid, detailed, and sometimes painful stories about work-life conflict.Theme: Specific experience of work-life facilitationHowever, some physicians clearly experienced work-life facilitation. Some faculty described facilitation from their work domain to their home domain. For example, one respondent shared, “I feel like I’m a role model to my children…by having a career and showing them what hard work and going to school and what all that means and why it’s important,” reflecting on how their dedication to and satisfaction from their job provides a good example for their children. Another faculty discussed how skills they learned at work transferred to their home domain, sharing that, as a doctor, he learned to place great focus on patients so that a 5-min visit may seem like 30 min to the patient and how, “it’s the same thing with your wife or kids.” Further, some discussed how their home roles can facilitate work roles, for example, how being a parent enabled them to communicate better with patients and their families – “I think being a mom has allowed me to be a better pediatrician. I can really relate to parents, their fears. I have a lot more patience for families, more knowledge. I can relate to kids better.”What are the consequences of work-life conflict for medical faculty and their family members?Theme: Consequences for both work and home domains.The greatest expressed consequences of work-life conflict were stress and exhaustion, the main component of burnout, which is feeling overextended and depleted of one’s emotional and physical resources . One intDespite being health care providers, faculty reported ignoring their own health as a result of work-life conflict. One respondent mentioned ignoring regular medical checkups due to work and family responsibilities, and another stated, “If a bunch of things are piled up and I can’t get to them because… I’m on service or… even with like a 12-h day, I come home, and you know, the kids are in bed and I’m right back at the computer to do more work…that’s not healthy. I think the long hours, I have really compromised things like you know, fitness and personal time and hobbies and down time.” Many faculty also described work-life conflict as leading to sleep deprivation. One faculty shared that they sleep about 4 h per night, while another explained how they worked, “a 12-h shift, on pretty little sleep, and that makes me very anxious because…I’m sort of in charge [in an acute care setting], and I worry that my lack of sleep could potentially affect my decision making.” Thus, the dangers of work-life conflict can also be a cause for concern for patient care and for the hospital.Theme: Consequences for home domain.In addition, the consequences associated with work-life conflict extended to some faculty’s children and spouses, as faculty reported frequently missing out on family dinners, attending children’s activities, and spending quality time with friends and family in order to work. A faculty member shared: “The children, that was hard, because you have to outsource everything, you’re just outsourcing all the time. And so, one of my children…said one time they were asking for donations to [the hospital], she stepped back, became a little red in the face and she said I gave my mother to [the hospital]. That’s a real tear-jerker and it’s true.” Another said that her daughter “insists she’s in therapy” because she was predominantly cared for by others while growing up. Although relationships with children can be strained as a result of work-life conflict, this is particularly true for partners or spouses. One respondent asked, “What do I do when my wife is yelling at me because I’m late again?” Further, some faculty members said that they don’t know their spouse well anymore because, although they put in considerable effort when it came to their children, their marriage was “easy to compromise” for work.In contrast, a few faculty reported that their prioritization of work over family may have a positive outcome on their children because they develop skills  that they might not otherwise. One faculty explained that while they recognize that they haven’t spent enough time with their children growing up, “having a working mom really facilitates their independence,” while another faculty shared, “I haven’t spent as much or enough time with my boys growing up. It has certainly made them independent in the extreme.” Thus, it appears that some faculty engage in cognitive reappraisals of their situation, such that they view their potentially negative experiences of work-life conflict in a positive light.Faculty also experienced negative affect as a consequence ofwork-life conflict. For some, the sacrifice of work overtaking alltheir time was a source of resentment, as work was seen to cause them to be absent from the lives of people they care about, for example, “It is hard to disconnect from work. So there are times when I resent that…if one of the kids has a hockey game or something and I can’t go because I am here with a patient or student after hours…you know, you can resent that for a little while.” Interestingly, only women in our sample shared experiences of work-family guilt, that is, the negative feeling that arises when one’s desired level of participation in a role is less than one’s actual level of participation . For insTheme: Consequences for work domain.As a result of work-life conflict, some faculty reported considering or temporarily changing to part-time employment to manage these aspects of their lives better. Only women mentioned either working part-time or wanting to change their status to part-time. For instance, one faculty described her 12-h workdays and said, “You do that a bit and all the wheels fall off. The children, grandchildren, certainly the husband…You’d think you’d have some sort of detachment but no. I just can’t put in those hours anymore.” In addition, another woman faculty shared, “The reason why I work [less than full-time] was so I could take my kids and pick my kids up from school 1 day a week…I took a 20 percent pay cut for 10 years of my career for that.” Thus, as a result of work-life conflict, women faculty are potentially feeling forced onto the “mommy track,” whereby they sacrifice their career progress and promotions in order to be present for their children.How do medical faculty’s job demands affect their work-life conflict?Theme: Coalescence of demands to create work-work conflict that leads to work-life conflict.While some demands had a direct relation to work-life conflict , by and large we found that job demands coalesced in a manner that drove faculty to work long hours resulting in work-life conflict. One faculty described this phenomena: “There’s always more work to be done, so it’s almost like a never-ending pit. You just try to do as much as you can and stay sane.” Faculty experienced a number of job demands that hindered their ability to conduct their work efficaciously and efficiently, or even created more work for them, such as poor equipment, unsupportive staff, and outdated, slow IT systems. These demands added to faculty’s already excessive workload, which was called a “constant, unrelenting, bombardment of tasks and requests.” These types of demands led to greater work-life conflict because they required faculty to stay at work late or bring work home.Medical and hospital culture expectations added to workload demands. For instance, faculty are expected to always be available for contact, to be available for early morning and evening meetings, to work until late at night, to self-sacrifice, and to give their work their all, as “there is a general philosophy that if you aren’t working 120% that you are not being productive, it’s a real strong sense that you should be working at home at night. You should be working every night till 2:00 in the morning…That’s a cultural thing that’s probably really not positive at all for people.” Indeed, more than one faculty said that they can get so busy that they do not go to the bathroom, and one participant shared a story of working out at the onsite gym  only to be greeted by 10 emails saying, “Where were you?” at the end.Faculty’s struggle with their excessive job demands should be considered in the context of their multiple work roles . Duties associated with each role often compete with each other for time and energy in an overloaded workday. One faculty member described their experience: “Administration eats a large chunk of my day and my week. Research expectations are still relatively important, even though there’s a large administrative component to my work. Expectations around education, both formal and informal. They all eat into the day. They’re all incredibly important. Research and education. That’s part of our portfolio because it’s a given that if you work in an academic unit, you perform, not just clinically but you perform administratively…So keeping all the balls in the air and continually juggling.”For faculty, there is work associated with their clinical, teaching, and administrative roles that can only be completed at the hospital , and despite “protected time” , clinical duties often take up the entirety of a typical workday. However, research is highly valued and prioritized, as it leads to grants, funding, and promotions; as such, faculty often have no choice but to take their research work home to complete. One faculty shared, “Everything is fast paced. The clinical work is certainly fast-paced, and I think that can take over the other work…If you don’t sort of try to make time for it, your research won’t get done and teaching sort of falls secondary.” Thus, not only do faculty experience extremely high job demands, these job demands also compete with each other for time and energy, leading to experiences of stress, and work-life conflict for faculty.Overall, faculty felt they were expected to be exemplary in all of their roles, particularly their research role. The culture emphasizes a standard of “excellence beyond excellence;” one faculty stated that negative outcomes such as stress and work-life conflict are “inevitable [in a place like this] because of the ridiculously high expectations. That’s the tone of the institution,” adding that people are selected because they are “driven and motivated and succeed, and that kind of perpetuates the expectations and demands and stress.” However, faculty were particularly burdened by the pressure to perform academically because, “it is not enough to be a good clinician” and, “it is still research that is most valued.” The hospital’s culture prioritizes research by celebrating research superstars, who are plentiful, and an awareness of “have” versus “have-not” divisions adds to a sense of differential value or status.The apparent emphasis on research is reinforced through multiple performance reviews, One faculty explained, “Every year…we have to update our CV, reporting changes that we’ve accomplished over the last year…the template that they give you to report only really wants to know about papers that you have published, conferences you’ve been invited to speak at, and research-oriented projects. So, for those of us who are not research-oriented, it really makes you feel like you’ve pretty much done nothing for the last year and that can be quite frustrating.” The performance reviews were widely acknowledged by respondents to reward research over clinical, teaching, and administrative work. However, a few faculty—all of whom had a heavy research profile—rejected the notion that research productivity is valued above all else and framed such a view as a “mythology” and a problem of the past. Regardless of their veracity, to meet these supposed standards, faculty devote considerable time to conducting research, writing grant applications, giving talks at conferences, and publishing papers, which comes at the cost of their home time. One interviewee explained, “the promotion process [is] standardized for a select group of people; generally, people that are very research focused…and it particularly is not aligned with someone who is a parent.” As a result, faculty experience this ‘perfect storm,’ wherein coalescing job demands lead to work-life conflict. This storm occurs when, in a context that expects excellence for all aspects of work, faculty’s multiple teaching, administrative, and clinical duties vie for limited time and attention during hospital hours and push out time that is meant for research, which needs to be prioritized. As a result, research-related work must be taken home, resulting in work-life conflict.Theme: Legitimization of work-life conflictNotably, some respondents perceived work demands and work-life conflict differently. Some participants rationalized work demands as an inevitable and expected part of the job, given their specialty or given their position at a top research and teaching hospital. One respondent said, “I don’t have a lot of time for people who whine about their life-work balance…it’s a personal choice you make,” while another said, “It’s silly to complain about [being on] call because I think it’s just part of the job…you’ve made that choice…[I chose a sub-speciality] that probably wouldn’t allow me to have a separate personal life.” Thus, some faculty appear to legitimate work demands and the effect on their own and others’ non-work life.(a) How do medical faculty’s job resources positively affect their work-life facilitation, and (b) do they positively and/or negatively affect their work-life conflict?Theme: Job resources lead to greater work-life facilitation.Given the lack of discussion of work-life facilitation, it was not possible to draw strong connections to job resources. However, a few respondents discussed how good salaries allow them to go on trips with their families or afford expensive hobbies, and several mentioned how their pay allowed them to afford childcare, which aided faculty to spend longer hours at work. One interviewee said that they’d be divorced if they didn’t have the employed household help, adding, “the domestic support is huge.” Thus, pay allows faculty to manage their work-life conflict and it enables them to throw themselves into work even more.Theme: Job resources help to lessen work-life conflict.supportive job resources, lessen work-life conflict. Supportive job resources – such as financial support from the hospital, competent administrative support, adequate physical resources, schedule flexibility, support from mentors/supervisors, as well as co-worker support to help cover shifts, train residents, and help with curriculum development – all lighten faculty workloads and help to streamline their work. One faculty commented on the collegiality within their division, “I think that if you need help with something, people will help you out. If you need help [with] last minute with things, people will help you. If my children were sick today, someone would do my work for me.” This reduces the need to work late or bring work home, thereby lessening faculty’s work-life conflict, even in the face of high job demands.It appears that having more job resources that help faculty get their work done or that help provide social support, which we term Theme: Job resources indirectly lead to more work-life conflictstimulating job resources, lead to greater work-life conflict. Stimulating job resources are those job resources that provide opportunities for growth and development, and opportunities for meaningful and impactful work. When faculty were asked what about their job is stimulating or motivating, almost all faculty answered with the vast opportunities to have interesting, dynamic, and varied work that is challenging and allows for innovation and specialization. One interviewee said, “the variety of what we get to do and the opportunity for growth and development and constant challenge…I don’t think you can find a parallel anywhere,” another stated, “It’s very interesting work that I do. It’s different every day. You never know what you’re going to get. I learn something new every day. It’s not static at all.”In contrast, it appears that having more, what we term, Faculty also enthused about how their job gives them opportunities to affect others’ lives. One faculty said, “To be able to [help patients]…to be a part of families’ lives when they’re going through crisis and to be able to help… there’s just nothing like it…Like, who gets to do this?” Further, faculty received immense satisfaction from working with trainees and felt the significance of training the next generation of physicians. Putting it all together, one faculty member shared, “I think it’s an amazing privilege to wake up every morning and come here and get to do what I do and see what I see and interact with the people I interact with, both co-workers and patients and families and trainees, all of the above. To get a paycheque for it at the end of the day is unbelievable.” It appears that the incredible, stimulating job resources that faculty have, such as opportunities for challenge and growth and the opportunities to make a difference in others’ lives, provide faculty with a sense of awe and gratitude. In addition, they also felt privileged to work at such an elite institution with such highly regarded colleagues.Together, these stimulating job resources led faculty to feel empowered, that is competent, autonomous, and feel their work has meaning and impact . Such higreater work-life conflict. Finally, we found many consequences to faculty’s experiences of work-life conflict for themselves, their careers, and their families.The current study examined novel insights leading to and resulting from physicians’ experiences of their work-life interface. Although our findings highlight the different ways faculty make sense and meaning of their experiences; some dominant themes emerged. In contrast to the vivid and dire descriptions of their work-life conflict, faculty had little to say about work-life facilitation. We found that physicians’ job demands interact with each other to contribute to work-life conflict, stress, and exhaustion. Further, the effects of job resources on work-life conflict appear to depend on whether they are supportive or stimulating in nature. Faculty described supportive job resources  as protecting against work-life conflict. In contrast, a pattern was revealed whereby stimulating job resources  lead to greater work engagement, more time investment in work, and subsequently First, in contrast to the job demands-resources model, the results of the current study reveal that the effects of job demands are neither unique nor additive . It appeSecond, and relatedly, we found that intra-role conflict or work-work conflict  can lead to work-life conflict, and importantly, the process through which this operates depends on the permeability of role boundaries and on the salience of the roles. While many faculty felt strong pressure to prioritize their research role; clinical, administrative, and teaching duties took up the majority of a long workday, as these duties must be completed at the hospital. Thus, we found that when intra-role conflict exists, it seemed that the job roles with less permeable boundaries  pushed out the job role with more permeable boundaries . However, given the salience of research to the hospital, university, and among faculty who internalize its importance, faculty are in a bind, as research tasks are left incomplete at the end of a long workday. As a result, faculty need to take their research work home, thereby interfering with time and obligations for home life, creating inter-role conflict. This pattern of findings suggests an importance contribution for role theory; namely that work-work (intra-role) conflict may be most likely to lead to work-life (inter-role) conflict when a highly salient work role has highly permeable boundaries. This possibility should be explored in future research.supportive, in that they help people to manage demands and meet the requirements of their job, or as stimulating, because they help promote growth and development. There are parallels between stimulating job resources and motivating factors , which lead workers to feel high job satisfaction and achieve high performance in Third, we found that job resources have a differential relation with work-life conflict, depending on the type of job resource. On the basis of these findings, we suggest an extension to the job demands-resources model: we propose that job resources can be classified as either increase work-life conflict because stimulating job resources  can lead individuals to feel more empowered and engaged at work, which can lead them to reinvest their time and energy , leading to greater work-life conflict, and eventual exhaustion , provide a sense of meaning and relatedness that may buffer against depersonalization. Similarly, stimulating job resources  provide many faculty with a sense of competence and impact that seemingly buffers against any potential loss of self-efficacy. Thus, our results suggest that stimulating job resources may protect workers from depersonalization and reduced self-efficacy because they increase feelings of psychological empowerment ; however they may be insufficient to protect against exhaustion as well c.f., . HoweverN = 30), as well as saturation of our findings.A clear strength of the current study is that we investigated work-life conflict among medical faculty at a top research hospital whose multiple work roles, heavy job demands, and extensive resources, made them a highly pertinent sample. Importantly, we were able to achieve a decent sample size . We had participants and stakeholders evaluate and support the interpretations of the findings; thus, the findings of the research also have demonstrated confirmability. Detailed notes kept by R.L. and V.G. of the research steps from start to finish, as well as clear notes throughout the coding process also provide support so that the findings and interpretations are consistent and potentially replicable .Finally, throughout the research process, discussions were held among authors, analysts, and stakeholders, who offered diverse feedback and perspectives through which to understand participants’ experiences. These varying perspectives helped R.L., V. G., and L.S.H. to confront biases and previously held assumptions and examine how they might affect our interpretations  should be accurately assessed and rewarded through fair evaluation systems administered not more than once every 2 years, and through informal support and recognition. In addition, hospitals should aim to build supportive job resources, such as well-trained staff, excellent residents, and ease of schedule flexibility. These changes should help faculty reduce some of the burdens of their workload so they may live more balanced lives. Organizations should also seek to support medical faculty to shape their jobs to be highly stimulating so that feelings of meaning and impact can stave off experiences of burnout. For instance, as much as possible, faculty should be given the physical , financial, and time resources they need in order to be able to develop new expertise and conduct research in novel ways.Given the role of job demands in leading to work-life conflict and the potential for supportive job resources to lessen it, hospital leadership should do what they can to reduce unnecessary job demands and to increase supportive job resources. On the basis of our findings, we recommend that organizations  reduce overly burdensome demands, such as poor IT  and performance evaluations that are too frequent and overly focused on one work role. More specifically, we recommend that excellent performance for healthcare, hospitals (and other organizations), should promote a culture in which a dedication to excellence is not put at odds with a commitment to wellness for staff. Rather, there needs to be formal recognition by administrators and physicians themselves that, for example, performance depends upon adequate sleep . In addition, organizations can work to combat against physician burnout by: explicitly including burnout as an indicator of well-being in engagement surveys, assessing burnout at the team- or department-level to understand underlying contributors, and encouraging input from staff and patients to gain deeper and holistic insights regarding physician wellness .Among our participants, men and women were equally likely to describe high levels of work-life conflict, which is consistent with previous meta-analytic research on workers in general . HoweverAdditionally, our research and findings have important implications for organizations that employ engagement surveys or other self-report measures, as well as for researchers who use these methods. Two of our findings call into question the ability of self-report survey methods to capture the work-life interface as researchers intend. First, our findings demonstrate that some faculty believed that their positive experiences at work must enrich their home lives (and vice versa), yet they had difficulty describing such experiences. If these faculty’s inability to articulate work-life facilitation reflects a lack of lived experience, they would presumably score high on a self-report measure of work-life facilitation (due to wishful platitudes), and yet, these reports likely would not predict the positive outcomes that should be associated with high work-life facilitation  but also high levels of stress and emotional exhaustion . Many medical faculty interviewed experience unmanageable levels of job demands that appear to coalesce and work in conjunction to force them to work long hospital hours and bring work home, and their high levels of work-life conflict had damaging effects on stress, exhaustion, self-care, and relationships with loved ones. However, they also enjoy very stimulating jobs that provide a sense of meaning and impact that motivates them to be highly engaged with their work. In order for current and future physicians to function and integrate their non-work and work lives, hospitals and the medical field more broadly may need to temper the culture of excellence and research productivity with one that also truly values physicians’ well-being, families, and lives outside of work.The datasets presented in this article are not readily available because the qualitative interview data include statements that are potentially identifying. Requests to access the datasets should be directed to Leanne Son Hing who can provide aspects of the data with identifying information removed.The study involving human participants was reviewed and approved by the University of Guelph Research Ethics Board and the Hospital’s Research Ethics Board. The participants provided their written informed consent to participate in this study.RL, LSH, and VG: conception and design of the study. RL, LSH, VG, and SW: interview guide creation. RL, LSH, VG, SW, and DD: acquisition of data. RL, LSH, VG, DL, and PH: analysis and interpretation of data. All authors contributed to drafting the article and revising it. In addition, all authors have given final approval and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Presenteeism negatively affects both individuals and society. This study identified factors of presenteeism among workers in South Korea, especially in relation to exposure to adverse social behaviors. Here, an adverse social behavior refers to any forms of workplace violence or intimidation. This study used the data from 23,164 full-time salaried employees, who participated in the fifth Korean Working Conditions Survey. This study attempted to predict presenteeism based on the exposure to adverse social behaviors and working conditions using logistic regression. Presenteeism was reported in 15.9% of the sample. Presenteeism was significantly higher among workers with the following characteristics: females, aged 40 years or older; middle school graduates; over 40 working hours a week; shift workers; no job-related safety information received; exposure to adverse social behavior and discrimination; and those with a high demand for quantitative work, low job autonomy, high emotional demands, and high job stress. The workers exposed to adverse social behavior showed a higher prevalence of presenteeism (41.2%), and low job autonomy was the most significant predictor of presenteeism. The findings of this study suggest that allowing enough autonomy in job-related roles may help alleviate presenteeism among those who have experienced adverse social behavior at work. Presenteeism has been used to refer to two slightly different meanings: people going to work sick ,2,3,4, oAccording to several theories of presenteeism, the determinants of presenteeism are mostly related to work, individual health, and stress . PresentPresenteeism should be connected with the working environment because it is affected by an institution . PohlingBased on these theories, previous studies have reported specific characteristics of the workers who decide on presenteeism. However, as most studies assumed that workers are in a healthy state without exposure to hazards, they could not show the specific factors of workers who have already been exposed to risk factors in the workplace that lead them to presenteeism.To develop and communicate suitable interventions that can help deal with this phenomenon study on presenteeism should consider the context in which the behavior occurs . In addiPresenteeism has differences between nations . AccordiAll acts of violence and intimidation at work, such as bullying, harassment, and violence in the workplace, are defined as an adverse social behavior at workplace . WorkersTherefore, examining how the experience of adverse social behaviors in the workplace, a subtle and non-physical factor, affects presenteeism is an area much needing research. In particular, it is necessary to identify the factors for presenteeism that apply only in workers who are exposed to psychologically adverse social behaviors. However, previous research on presenteeism has mostly included workers as a single group or did not consider adverse social behaviors as an antecedent risk that threatens the health of the subject, including only working conditions. Instead, they have mostly focused on the health problems, reduced productivity, and specific job types of workers .Studying presenteeism is particularly important in the context of the South Korean workplace, where overwork leads to many social problems including employee suicide. Examining presenteeism may elucidate the causes of many workplace related issues, and also, identify potential solutions for them. Nonetheless, there are few studies on presenteeism in South Korea .By analyzing national workers survey data from South Korea, this study aimed to inform the development of workplace policies and managerial strategies that effectively address presenteeism among South Korean workers exposed to psychologically adverse social behavior. The specific aims were: (a) to identify the factors of presenteeism among workers in general, and (b) to identify the related factors of presenteeism among those who have been exposed to adverse social behavior.This study was a secondary analysis of the data collected through the fifth Korean Working Conditions Survey of the Occupational Safety and Health Research Institute (OSHARI) in South Korea. It was approved by the Institutional Review Board (IRB) of D University (Pro00104026).This study used the data from 23,164 full-time salaried workers among 50,205 employees who participated in the fifth Korean Working Conditions Survey (KWCS). The Korean Working Conditions Survey is a government-approved survey that has been conducted since 2006 to identify work-related risk factors among South Korean employees. The survey questionnaires were developed by researchers and government administrators in the field of occupational safety and health, benchmarking the European Working Conditions Survey (EWCS) and the UK’s Labour Force Survey (LFS). The initial set of questions were validated through a face-to-face interview of workers to ensure the correct understanding of the question. The questionnaire was finalized, incorporating the input from Statistics Korea and the National Institute of Korean Language .This survey targets all employees in South Korea who are economically active, older than 15 years old, and worked for more than 1 h for income purposes over the previous week at the time of the survey. The participants were selected from across South Korea, using a multi-stage systematic cluster sampling. Trained interviewers visited the selected homes and gathered the data using the computer-assisted personal interviewing (CAPI) method. The datasets generated by this survey series have been used in numerous occupational health studies in South Korea ,33,34.Demographic variables included for this study are gender, age, education level, and income.The job-related information incorporated in the analysis are job type, hours worked per week, company size, years of service, work shift, and safety information provided at work.The respondents were asked to answer “yes” or “no” regarding whether they had ever been exposed to various adverse social behaviors, such as verbal abuse, unwanted sexual attention, threats, or humiliating behavior from clients at work, over the past one month. This study considered that the respondents were exposed to an adverse social behavior if they answered “yes” to one or more of these items.The participants were asked whether they had experienced discrimination at work during the past 12 months in relation to age, ethnic group, nationality, gender, religion, disability, sexual orientation, academic background, hometown, and employment type. If the participants answered “yes” to at least one item, they were deemed to have experienced discrimination.Working conditions consisted of quantitative and emotional demands at work, job autonomy, job stress, and social support from colleagues and managers. Each variable was classified based on the criteria provided in the sixth EWCS .The question on quantitative demands inquired if the respondents had “enough time to do their jobs”, and answers of “never” or “rarely” were assumed to indicate a high degree of quantitative demands, and “always”, “most of the time” or “sometimes” were assumed to indicate a low degree of quantitative demands. Job autonomy was determined via the interdependency of five items that can affect the completion of work, such as: (1) the work done by colleagues, (2) direct demands from people, such as clients, passengers, pupils, patients, (3) numerical production targets or performance targets, (4) the automatic speed of a machine or movement of a product, (5) the direct control of their boss. If the respondents selected three or more items “yes”, they were considered to have a low degree of job autonomy. As for emotional demands, the participants were asked if they were hiding their feelings at work. If the answers of “most of the time” or “always” were considered as high emotional demands and “never”, “rarely” or “sometimes” were considered as low emotional demands.Different levels of job stress were defined based on the responses to the item, “I am under stress at work”. If the respondents indicated “always”, “most of the time” or “sometimes”, they were considered experiencing a high degree of stress and “never”, “rarely” or “sometimes” were considered to be experiencing a low degree of stress. Regarding social support from colleagues and managers, the respondents were asked how often they receive “help/support from colleagues” and “help/support from managers”. If they marked “most of the time” or “always”, they were deemed to have a high degree of social support, and “never”, “rarely” or “sometimes” were deemed to have a low degree of social support.To discern presenteeism, the participants were asked, “Over the past 12 months, have you ever come to work even though you were sick?” . If theyData analysis was performed using SPSS 25.0, with a 95% significance level. Frequencies, percentages, and chi-square tests were obtained to describe the characteristics and presenteeism of the participants. Using complex samples of logistic regression, the study attempted to predict presenteeism based on the respondents’ demographics, occupational characteristics, exposure to adverse social behavior, discrimination, and working conditions.This analysis used a weighted sample to increase the estimates’ accuracy by matching the composition of the population, thus, preventing sampling bias. The weights were used by multiplying the sampling weight, the non-response weight, and the post-stratification weight.When compared by the exposure to an adverse social behavior, similar distributions of the sample characteristics were observed in the subgroups; the sample characteristics are significantly different except for age, company size, social support from colleagues and managers. The exposure group included more service and sales workers (43.9%) and reported a slightly higher rate of discrimination, quantitative demands, emotional demands, and job stress. The exposure group reported a higher rate of presenteeism (41.2%).While supporting the findings of previous studies that identified contributing factors of presenteeism, the results of this research extended the current understanding of presenteeism by providing additional understanding of the factors that potentially contribute to presenteeism among workers who have been exposed to adverse social behavior.This study demonstrated that the risk factors of presenteeism are multidimensional, ranging from organizational culture and job-related elements to individual differences. This finding is consistent with a previous study that showed that presenteeism is influenced by complex factors .This analysis showed that women experience more presenteeism than men, which may be explained by the traits that females share to some extent. Previous research has reported that women tend to focus on others, display more symptoms of illness, and come to work even though they may be sick  ,37. ThosPresenteeism is known to be more prevalent among younger workers . HoweverThe existing literature implies that a high degree of job demands, a high amount of pressure in terms of time, shift schedules, and long working hours are key risk factors of presenteeism ,18,40,41High job stress due to mental health or psychological problems is known as a major determinant of presenteeism ,18. KaraAn expert panel convened by the American College of Occupational and Environmental Medicine (ACOEM) recommended considering emotional demands when designing measures to prevent presenteeism . This stEmployees who are overworked or feel unsafe on the job are likely to become ill . TherefoThis study investigated the risk factors for presenteeism among workers who have been exposed to an adverse social behavior and revealed that job autonomy is the most significant predictor of presenteeism. This result supports previous research findings that if only unhealthy subjects are selected, the factors associated with presenteeism identified for healthy workers disappear or decrease in intensity . Our resResearch has found that psychologically adverse social behavior is a significant risk factor for presenteeism . HoweverIn particular, this study demonstrated that the level of job autonomy is a critical factor in presenteeism among workers exposed to adverse psychological social behavior that makes them more vulnerable to presenteeism ,18,42,50However, managers often consider the degree of disease or stress to be at a level that workers can endure on their own and tend to take presenteeism positively. Furthermore, workers may think that their absence would be a burden on others by causing them to take over their work, and feel peer pressured to report to work even if they are sick  ,53. ThusPresenteeism increases the risk of health issues and long-term absence . HoweverThe employers in South Korea certainly need to revise their sick leave policies of their company ,44 and nThis study has some limitations. First, the analysis was conducted using self-reported survey data, which represents subjective experiences. Therefore, the findings of this analysis may have limited generalizability. Second, because it is a cross-sectional study, the interpretation of the causality on the relevance of each factor to presenteeism should be made carefully. Third, as the study employs a secondary analysis of an existing dataset, the investigation of the presenteeism was limited to the factors available in the dataset. Fourth, this study did not conduct exhaustive analyses on the complex interaction effects that may exist among worker’s characteristics in relation to presenteeism. A follow up study will address this gap in the analysis.Nevertheless, this study has several merits. First, it used the most comprehensive national survey on health and working conditions among South Korean workers. Second, it investigated the factors of presenteeism among employees exposed to adverse social behavior, a serious issue worldwide. Third, it broadened the understanding of presenteeism by suggesting directions to remedy workers’ circumstances and to establish a basis for practical measures.Presenteeism is linked to diverse factors ranging from job-related ones to individual differences. This study showed that workers exposed to psychologically adverse social behaviors at work should be treated as an important target. Among those who have been exposed to an adverse social behavior, lack of job autonomy is the most critical risk factor of presenteeism. This study suggests that it is important to provide employees with sufficient autonomy for job-related roles in order to alleviate presenteeism among those who have been exposed to adverse social behavior.Employers and companies may need to consider various strategies to effectively mitigate presenteeism by assessing whether employees are exposed to workplace adverse social behavior, and allowing workers exposed to workplace social behavior sufficient autonomy in conducting their work. In particular, we developed a specific strategic plan and objective standard for addressing presenteeism among workers exposed to psychologically adverse social behaviors. In addition, there is a need to recognize the exposure to adverse social behavior in the workplace as a serious health concern covered by sick-leave policies.


Bell-type inequalities are proven using oversimplified probabilistic models and/or counterfactual definiteness (CFD). If setting-dependent variables describing measuring instruments are correctly introduced, none of these inequalities may be proven. In spite of this, a belief in a mysterious quantum nonlocality is not fading. Computer simulations of Bell tests allow people to study the different ways in which the experimental data might have been created. They also allow for the generation of various counterfactual experiments’ outcomes, such as repeated or simultaneous measurements performed in different settings on the same “photon-pair”, and so forth. They allow for the reinforcing or relaxing of CFD compliance and/or for studying the impact of various “photon identification procedures”, mimicking those used in real experiments. Data samples consistent with quantum predictions may be generated by using a specific setting-dependent identification procedure. It reflects the active role of instruments during the measurement process. Each of the setting-dependent data samples are consistent with specific setting-dependent probabilistic models which may not be deduced using non-contextual local realistic or stochastic hidden variables. In this paper, we will be discussing the results of these simulations. Since the data samples are generated in a locally causal way, these simulations provide additional strong arguments for closing the door on quantum nonlocality. In classical physics, we are used to thinking that physical observables characterizing a certain state of a physical system have definite values, even if they are not measured. This assumption is sometimes called counterfactual definiteness (CFD). When we look at a table, we may define its different attributes: its size, dimensions, weight, the type of material it is made of, and so forth. It is natural to think that definite values of these attributes do exist, even if we do not measure them, and that by making more and more precise measurements we may estimate these definite values with arbitrary precision. Even in classical physics, many of these attributes are relative to their experimental context, such as temperature, a place on the Earth, ambient light, and so forth. Nevertheless, we may still believe that the attributes have definite values in each particular fixed environmental context. According to CFD, we may describe ensembles of physical systems using joint probability distributions of several physical variables, even if we do not measure them. CFD was applied with success in statistical mechanics, but failed to explain the motion of electrons in atoms and in many other quantum phenomena.According to quantum mechanics (QM), as Peres stated, unperformed experiments have no results . In QM, QM predicts strong correlations between outcomes of spin polarization measurements in an idealized EPRB experiment, performed on “photon pairs” prepared in a singlet state ,9. SeverIn 1964, John Stewart Bell constructed a local realistic hidden-variable model (LRHVM) in which the clicks on detectors were completely determined by some hidden variables describing each pair of photons prepared in the spin singlet state. LRHVM is CFD-compliant because the outcomes of all spin measurements are predetermined before the actual measurements are done. Using a unique parameter space and a joint probability distribution, to describe four mutually exclusive random experiments, he proved his famous inequalities and showed that according to QM they should be violated for some experimental settings ,17. For Idealized EPRB experiments cannot be realized in the laboratory; since we cannot follow “entangled photon pairs” from the moment when they are produced to the moment when they arrive to the detectors. We may only record the clicks on distant detectors and the time of their registration. To compare experimental outcomes with quantum predictions, one has to identify which clicks correspond to the “twin-photon pairs” we are interested in. These experimental uncertainties are known as: time-coincidence, detection, fair-sampling, or photon identification loopholes ,27,28,29Various Bell-type inequalities are violated by quantum predictions and by experimental data ,13,14,15It was pointed out by several authors ,71,72,73quantum nonlocality: “In a theory in which parameters are added to quantum mechanics to determine the results of individual measurements, without changing the statistical predictions, there must be a mechanism whereby the setting of one measurement device can influence the reading of another instrument, however remote. Moreover, the signal involved must propagate instantaneously, so that such a theory could not be Lorentz invariant.” When the violation of Bell and CHSH inequalities was confirmed in SPCE, he concluded that a causally local explanation of quantum correlations was impossible, and that Nature was non-local. Bell believed that LRHVM and SHVM were the only possible local descriptions of EPRB; thus, the violation of his inequalities would mean that QM violates Einsteinian locality. In  he gave Let me provide a simple explanation on why and how a possibility of the violation of Einsteinian locality is discussed in the context of an idealized EPRB experiment. Let us assume that Harry prepares “photon pairs” in a spin-singlet state, and sends one photon to Alice and another photon to Bob. After passing by respective PBSs, chosen in a particular pair of settings, the photons produce clicks on one of two detectors placed behind both Alice’s and Bob’s PBSs, respectively. The clicks are interpreted as the detections of photons either ”spinning up” or “spinning down” in a direction determined by the settings of PBSs, and observed events are coded by ±1. quantum nonlocality. Two photons are often compared to two fair dice in distant locations, which, in each throw, produce perfectly matching outcomes. By definition of randomness, perfectly random outcomes cannot always match perfectly. This means that some spooky instantaneous influences exist between distant dices, which are forbidden by Einstein’s locality. Since experimental settings may only be defined by small spherical angles, QM does not predict strict anti-correlations between Alice’s and Bob’s outcomes . Please note that outcomes x do not depend on the parameters r; thus, these parameters could be assigned not to the incoming “photon pairs” but to the observation stations. Such an interpretation is adopted in the paper , where c is a small positive number. We see from (2) that if r is close to 0, the outputted time delay is negligible, no matter which setting is chosen.Let us change slightly the assignment of the variables used in (1) and (2), and describe an “EPR-pair” by  and measuring devices by ((a − φ) in (2) was chosen to reproduce quantum predictions. The possibility of the existence and implications of time delays in Bell experiments were discussed in detail for the first time by Saverio Pascazio [predictably complete. Of course, the dependence of time delays on Pascazio . The depPascazio . .In ourpredictable completeness of QM, one has to search for unexpected regularities in the experimental time-series of data [In several papers, we advocated that in order to check the  of data ,102,103. of data ,108.In classical physics, statistical ensembles of physical systems may often be described by probabilistic models using joint probability distributions of several physical variables, even if we do not measure all of them at the same time. It is assumed that a measurement of any particular property does not change other properties which are not measured. LRHVM describes only a counter-factual random experiment in which, for each “photon-pair”, all spin-projections are simultaneously measured by Alice and Bob in their available experimental settings. If outcomes are coded “±1”, the recorded data form quadruples  and pair-wise correlations estimated using these data may never violate Bell inequalities. Pair-wise correlations for different pairs of settings in Bell-experiments are estimated using the data coming from mutually exclusive random experiments, and they do not need to satisfy the constraints resulting from the existence of the counterfactual joint probability distribution. Apparently, theoretical arguments based on probability spaces and the properties of random variables have not been sufficiently convincing. The outcomes of computer simulations are perhaps easier to understand. Computer simulations allow for the generation of data sets for several counterfactual experiments, such as repeated measurements on the same “photon pair”, joint or successive measurements performed on the same” photon-pair” in different settings, and so forth. Using counterfactual protocols, quadruples  are generated for each “photon-pair”. These quadruples may be displayed in a 4 × 4N spreadsheet. If pair-wise correlations are estimated using this spreadsheet, Bell and CHSH inequalities are satisfied for any finite sample. It does not matter whether the outputs ±1 are predetermined  or generJoint probability distributions are only well-defined if we measure several random variables at the same time, such as the weight and height of a student, the numbers on two dice rolled together, and so forth . If we wIf, in computer simulations, only pairs of outcomes are outputted for each “photon pair”, some finite samples may violate Bell-type inequalities, but not as significantly as in real experiments. Final data samples are created using “photon-pair identification” procedures, mimicking the procedures used in real experiments. Similarly, as in real experiments, post-selected samples depend strongly on time delays, time windows, and voltage thresholds. Each of these post-selected samples is consistent with some specific setting-dependent probabilistic models. For some specific values of adjustable parameters, such models reproduce exact quantum predictions for EPRB experiments. Computer simulations provide direct proof that Boole- and Bell-type inequalities are a necessary and sufficient precondition for the existence of GJPD, from which the pair-wise correlations between random variables may be deduced. Such GJPD does not exist for the random variables measured in Bell tests. Moreover, using locally causal algorithms, they give a more detailed description of how individual data items might have been created in real experiments. Such a detailed description is out of the scope of QM and was believed to be impossible. Therefore, we cannot close the door on the Bohr-Einstein quantum debate ,81, in sBell-type inequalities have been violated in ,13,14,15contextuality has recently been given by Kurt Jung [A completely different argument in favor of locality and urt Jung . He deriThe correlations between distant events in the natural and social sciences have recently been studied by means of integrable systems and nonlinear dynamical modelling. A lot of papers have been published in this new domain called AB science, in which such correlations are explained in a rational way. The discussion of AB science is out of the scope of this paper, and the references may be found in .In EPRB, one is interested in the coincidences between the events in distant locations. It is interesting to mention that, perhaps due to the general relativity, the possibility of exact and absolute coincidence events might be an illusion .quantum nonlocality as it is understood in the context of Bell tests. Relativistic invariance is incorporated in quantum electrodynamics and in the Standard Model. As with any physical law, it might be violated in high-energy physics, and has to be tested ,114. Evequantum nonlocality. We conclude that various theoretical arguments, reviewed in this paper and locally causal simulations of Bell experiments, allow for a “closing of the door” on


Misfortune is only that what should not happen, but still happens. Misfortune is always caused by people. Nature rules with that what must happen.” We live in strange and dangerous times. The COVID-19 pandemic and restrictions imposed to contain it have in many ways adversely affected our daily functioning, with self-isolation and lockdown having a particularly damaging effect on mental health. This situation has caused different physical, psychological, and social manifestations on an individual, group, and social level. Individuals are experiencing anxiety, fear, panic, or paranoia, while communities and society are experiencing a crisis, with authorities desperately searching for appropriate responses. Both individuals and society as a whole are facing trauma.This pandemic is often referred to as a “war-like situation.” The terms “war” and “pandemic” are used almost interchangeably to describe the current situation, but are these terms equivalent? Arguably, both war and pandemic lead to the collapse of the external safe environment and the phenomenon of “pathology of boundaries.”The historical perspective of wars around the world, including those in the former Yugoslavia, confronts us with the experience of violated borders, breakdowns, destruction, loss of authority, disintegration, devastation, and a lack of empathy and humanity. In a war environment, both the individual and the society are faced with a different way of functioning, the need for adaptation, which undoubtedly generates painful, traumatic experiences.In this article we present our clinical work with several patients from the former Yugoslavia in whom the pandemic caused a re-traumatization of the war experience. The first aim is to show the similarities and differences between wars and pandemics in terms of the way we are facing the situation. Traumatic experiences of pandemic and war are different in “their nature” and similar and different in their “pathological effects and consequences.” The second aim is to show that psychoanalysts can offer safe enough space and time, and an-other person, for re-traumatized patients to repair individual and collective trauma. The third aim is to show that individual trauma can only be repaired through both the individual psychotherapeutic process and the group thinking and dreaming processes. The individual trauma can only be elaborated, worked-through, and repaired on a collective level.The purpose of this article is not sociological consideration, or a political analysis. As psychoanalysts, we would like to offer one interpretation of the connection between the pandemic and war experiences, through an analysis of clinical material from individual practice, which was also discussed in the peer group processes. In this way, we will try to present how we can start transforming trauma and re-traumatization into a process of reparation.The psychoanalytic peer group “Sophia” is a group of five psychoanalysts from four countries of the former Yugoslavia. The clinical material presented here is the material from our clinical practice. The material and processes from the individual psychoanalytic work of our members were brought to the group and were re-thought and re-dreamed in the group processes. Individual clinical work of re-traumatized patients was elaborated again on a collective level. Our members from Sarajevo and Belgrade used the group processes and “group mentality” as a safe-enough environment with functional barriers. In this way, the analyst could broadly and safely work through her own clinical material and later bring “the collective, group material” into the analytic setting. The patients of our two group members “became” patients on a collective level (of our group) and were “involved” in parallel thinking and dreaming processes .Wilfred Bion says that when meeting an-other person, an individual “loses his own mind and identity.” Two people are already a group. Let us add that in addition to losing one’s mind, one is getting a “new individual and collective, group mind and identity” – “group mentality,” which is in constant process of changing. He calls this the proto-mental system of the group. The processes in the group function on the level of “basic assumptions” when the group is faced with primitive ways of connecting and disconnecting. In crisis situations, such as war or pandemic, very extreme and pathological processes in the group prevail. These are paranoid and schizoid states of mind , when destruction, hatred, killing, colonizing, or torturing an-other group are viewed as “normal.” We deal with a group that is losing its mind – a group (or society) that goes insane. The chaos reigns and the group in despair tries to find a narcissistic leader – the magical savior-dictator and ideology that will save them all and forever. This solution is only temporary and decreases the overwhelming anxiety, fear, and paranoia, and will soon end in another collapse of the system, another broken and dysfunctional barrier, another war, and another collective trauma ,2. How cThe analysts working with patients who have experienced collective trauma and those who assimilated it trans-generationally need to expand their mental container (the capacity for thinking about trauma) . The anaWhen faced with a danger, people who have not had the privilege of living in “war-free zones” for a few generations immediately start to link that particular danger to war. This can be attributed to an individual, collective, and trans-generational traumatization and re-traumatization. Here, psychoanalysis has a lot to offer, as it deals with various types of traumas and unconscious links to a broad array of symptoms.These points were first addressed by Sigismund Freud, who was dealing with the concept of trauma all his life. At the very beginning  he equatSubsequently, Michael Balint was the first to develop the concept of situational trauma, placing the object in external reality, thus putting the mother-child relationship, ie, their harmony, in the foreground . In contThe theoretical concepts were expanded by Leo Rangel (1967), who introduced “vulnerability to trauma,” a very important clinical indicator that distinguishes traumatic from pathogenic . AccordiIn an attempt to define collective trauma, Dori Laub emphasizes the demolition of empathic protective shield, made up of internalized primary objects, which makes the person lose confidence in good objects that have the capacity to give meaning to experience . What reIn line with modern theories thus presented, Rene Kaes and others stress that collective trauma damages the semipermeable membrane between reality and fantasy, and the subject is reduced to an anonymous individual -21. SociOne of the most important tasks of analysts is to “tame” the trauma . The trauma can be tamed with the help of metaphors, with finding a name for traumatic experiences, in order to place it in a certain conceptual framework and thus limit its destructive power. Besides naming, we need to give meaning and explanation to experiences, which, according to Willie and Madeleine Baranger, is the place where psychoanalysis begins and where the analytical couple is born .What we call an individual human being, a psyche, a container, an analytical setting, a group, a social group, an institution, a nation is not a closed system. It is a system that is in a constant dialectical relationship between outside and inside. Furthermore, the relation between inside and outside is characterized by a complex dynamism and manifestations of different psychological material, such as emotions, dreams, events, memories, sensations, associations, which give rise to turbulence, constant change of states, catastrophic points. The boundary or barrier between inside and outside is something that we may use when describing a precise line of separation or a buffer zone. When we deal with boundaries in human relations  and in psychoanalytical sense, we talk about their strength, elasticity, rigidity, permeability and capability of holding, containing a situation of and within an encounter/clash. When we talk about a damaged, broken, ruptured barrier and its functioning, we talk about the “pathology of boundaries” .Damage of different quality and quantity may have different causes and different consequences. Paranoia is one of them. One of the extremes is a complete barrier destruction, which devastates the system and individual, namely causing chaos in a group or psychosis in an individual. The other extreme is when the barrier becomes hermetically sealed, non-permeable, with no elasticity. This extreme may cause a catatonic and autistic state of functioning, a complete isolation of the individual from the outside world.During the pandemic, all our patients felt that something had changed. Moreover, all patients began to see the resemblance between the epidemic and war events. The same thing happened to psychoanalysts – we experienced a change in our feelings toward ourselves and our environment, especially patients. For example, the analyst from Sarajevo said that she “returned home unusually tired and exhausted” although her workload was comparable to that before the outbreak. She explained that she, and especially the patients, had a reduced processing capacity. One young male patient described his condition in the following way: “I feel lonely and can't work, and just lie in bed,” whereas a young female patient stated that she was “in panic because of her parents and son.” All these reactions of passivity and mortification could be a result of a traumatic experience during the siege of Sarajevo. Even so, some patients who more directly experienced war trauma also linked it directly to the epidemic. Quarantine isolation resembled the isolation experienced during the exile. The epidemic shook like an earthquake all those who were affected by the war and other traumas, and who established a fragile psycho-sociological balance within their environments, and forced them to regress. In reality, during the epidemic, an earthquake hit Zagreb and further “shook” the whole area and its fragile defenses after the war trauma. Consequently, one young female patient from Sarajevo said that she “panicked after the earthquake in Zagreb and felt helpless, which made her angry because of a reduced possibility of control.” One middle-aged female patient from Zagreb wondered “what awaits us next,” referring to the plagues of Egypt described in the Bible.On the other hand, the “shaking of the sociological setting” sometimes caused quite opposite feelings. Another young female patient from Sarajevo stated that “the COVID epidemic put us all in the same situation” and that she “overcame her insecurities by cooking and nurturing flowers, which significantly relaxed her.” A young female patient from Belgrade described the lockdown experience “as her private space and time, freedom and security, and stability and change, in spite of the reality of going to work almost every day in a situation of danger.” This patient, although young, without memory of the war events, was still strongly marked by the war on an unconscious level. Her date of birth coincides with a major battle, a fact that stimulated certain internal processes and allowed her to start “moving” something inside herself. She stated that “some unconscious process happened and something has been opened.” She gained “the ability to explain how she feels, and the ability to feel love without needing to identify in total, and intimacy and sharing were possible again.” She found the time to think without guilt about things that are “stupid but dear to me,” such as going to the hairdresser’s or beautician’s. As if she was introduced into “something that gives life lightness and carless tone.” Before that, she started her analytic travel by talking about clothes for older women that her mother bought for her, as if she was 40 rather than 28. During the lockdown, she started wearing “sports clothes” and “casting aside the need to impress anyone.”Therefore, the patients experienced opposite reactions to the pandemic, and it was up to analysts to detect the change of environment. However, all these reactions, prompt analysts’ and delayed patients’, were connected to war trauma, as if any new trauma “short-circuited” to war trauma.Let us now discuss our patients' reactions provoked by the war and pandemic in relation to the “pathology of boundaries.” Two described extreme situations in war and pandemic are both traumatic but they differ in clinical presentation. Either in war or in a pandemic, there are different protective reactions and measures on an individual and collective level. In the presented clinical material, we can easily observe the “pathology of boundaries.” Both COVID-19 pandemic and war are traumatic for an individual, a group, or a system. Both situations are repetitive and experienced as (re)traumatization on the level of barriers. We can recognize dysfunctional or collapsing barriers in the individual and in the system.In analytical space – our clinical setting – a safe-enough container, these patients can establish a relation with an-other person . In this space, the patients in Sarajevo and the patient in Belgrade could experience their dysfunctional barrier and repair it, which prevented them from being re-traumatized by the pandemic situation.According to theoretical ideas, our patients are trying to transform their trauma from a “purely economic” (which is connected to symptoms and not to the thinking processes) to a trauma that will be assimilated into the history of the individual and the group. Often, brutal events , if they remain meaningless, become only incidents and intruders destined for repetition. Thus, analytical work creates the opportunity to transform repetition and experience of death to thinking and historicization .Furthermore, patients were sharing the ideas and memories of traumatic war experiences in Sarajevo under siege. The analyst helped them with her own counter-transference feelings and with dreaming with them about their experiences in a state of reverie. This process helped the patient and the analyst to deal with the material in a consulting room. The analyst, being aware of her own traumatic experiences, could offer them the space – the container with safe and functional barrier – where patients could evacuate and express their own unbearable feelings and emotions, and this would help them understand what was happening. Later, when lifting of the restrictions reestablished the boundary and function of the barrier between inside and outside, the level of unbearable individual and collective anxiety decreased.The psychoanalyst assumes the role of a participating witness ,25. The It is interesting how “isolation” and the autistic position helped one of our patients to repair early traumatic experiences in her family. In an isolated position, this patient did not just take part in remembering and repeating, but repairing and being creative. She used the analytical frame and setting and her relation with the analyst to feel safe enough, which caused or triggered her memories that were dreamed, thought, and worked through in an isolated-autistic position. She at last became a creative adolescent, and in parallel re-experienced and worked through her traumatic situations with her mother. At the same time, the isolation brought up images and memories of her childhood related to her birthday that coincides with a major battle and a picture from war in her home.Let us finish with two possible metaphors that describe our profession. In both individual sport and team sport, a professional needs a team to progress and develop. In team sport, it is the individual's team or group, while in the individual sport it is a team of trainers and staff.The same applies to artists or scientists. Artists cannot work on an individual level. Even if they isolate themselves in an autistic position, when presenting their work to the public they will be faced with a group (collective mind). The artist starts to communicate with “an-other people mind-group mentality.” Only when an artist is faced with a group and is “recognized in a group,” he or she gets the validation and confirmation of the artwork in a larger container – society.The COVID-19 pandemic has shown us that we can be connected as human beings and express empathy, solidarity, and humanity. War, unfortunately, gives rise to quite the opposite experiences – human beings often lose their “human faces,” and groups and systems are destroyed or fight each other. As a society, we will probably soon find a cure for COVID-19. However, we will certainly need much more time to find the “cure” for the collective and individual  trauma caused by wars and their consequences. We hope that this text could give some directions toward reaching this goal.