Functionality as defence: A deep-structure hermeneutic study of institutional coping and professional identity during the COVID-19 pandemic

Abstract

This article examines how healthcare professionals working on COVID-19 wards experienced psychosocial burdens during the pandemic and how they managed these within the intersecting pressures of personal vulnerability, professional duty, and institutional expectation. Drawing on deep-structure hermeneutics, 13 qualitative interviews were analysed to explore latent meaning structures underlying professional discourse. From this corpus, one analytically rich interview was selected for an in-depth single-case analysis. It illustrates how a rhetoric of positivity and a strictly maintained professional role served as protective defences against anxiety, helplessness, and loss of control. Within this dynamic, functionality emerged as a latent mode of coping that re-established a sense of agency and order, yet simultaneously suppressed emotional expression and acknowledgement of personal needs. These findings reveal a psychosocial paradox at the heart of clinical work under crisis conditions: maintaining reliability and composure while risking emotional detachment and exhaustion. As a theoretically informed implication of these findings, we propose the potential value of “spaces of non-functioning”—temporary contexts that allow relief from performance demands without destabilising professional identity. Such protected spaces may provide a more sustainable balance between care for others and self-care within the culture of contemporary healthcare.

Introduction

Healthcare systems across OECD countries are approaching a critical threshold, marked by financial austerity and persistent workforce shortages (OECD, 2023). In Austria, for instance, staff scarcity has led to the closure of hospital units and the withdrawal of services (Krutzler, 2023). These developments signal a deepening crisis of care—one that threatens not only the efficiency of medical provision but also the social foundations of equity, participation, and self-determination. The societal importance of healthcare became acutely visible during the COVID-19 pandemic. Despite uncertainty, exhaustion, and moral strain, hospitals continued to function, largely preventing systemic collapse. Yet this apparent resilience concealed profound vulnerabilities. Numerous studies have documented increased psychological distress among healthcare professionals—particularly nurses—manifested in anxiety, depression, and post-traumatic stress (Brune et al., 2024; Duden et al., 2023; Eichenberg et al., 2024; Kramer et al., 2021; Lee et al., 2023; Skoda et al., 2020; Smeltzer et al., 2022). These strains did not emerge in isolation but intensified long-standing structural and emotional fragilities that predated the pandemic (Bär and Starystach, 2018).

Beyond documenting distress, however, a crucial question remains: how healthcare professionals experienced this burden and how they managed it under crisis conditions. Approaching the material with this focus allowed latent coping dynamics to emerge through the interpretive process. While participants often emphasised stability and manageability at the manifest level, the deep-structure hermeneutic reading revealed a recurrent underlying pattern: the mobilisation of functionality as a way of maintaining psychic and institutional stability. These findings invite a shift in analytical focus—from merely assessing burden to exploring the psychodynamic mechanisms that became visible when professionals narrated how they coped in crisis. Accordingly, the core contribution of this study is the reconstruction of how functionality operated in practice—how “functioning” was made to function under crisis conditions. Functionality, in this sense, is not merely performance but a complex psychosocial phenomenon: both a defence and a resource. These questions resonate with emerging scholarship that interrogates the moral and affective dimensions of resilience in healthcare. Einboden (2020) critically examined the “hero discourse” that idealised healthcare professionals as self-sacrificing figures, maintaining institutional order through personal denial. While such narratives offered symbolic recognition, they also reinforced expectations of limitless endurance, masking the structural conditions that produce vulnerability. By contrast, McHugh et al. (2025), drawing on the Capability Approach, conceptualised wellbeing as grounded in competence, relatedness, and meaning rather than autonomy. Their findings suggest that functionality, when embedded in purpose and relational connection, can constitute a meaningful expression of agency rather than mere compliance.

Building on these perspectives, the present study explores the psychodynamic dimension of how burdens were negotiated at both manifest and latent levels, and how unconscious defence mechanisms, embedded within professional culture and institutional frameworks, shaped the ways participants narrated their experiences. Using deep-structure hermeneutic analysis, we reconstruct how the dynamic of functionality emerged through the interpretive process as a central mode of coping that both protects against psychic disintegration and constrains emotional expression. The study contributes to an interdisciplinary understanding of resilience by connecting psychodynamic inquiry with socio-institutional analysis. It illuminates the paradoxical processes through which professional identity, institutional demands, and societal narratives of duty coalesce to sustain care under extreme conditions—while revealing the unconscious cost of maintaining functionality as a moral and institutional imperative. Furthermore, because emotional experience and regulation are dynamically shaped by sociocultural contexts (Mesquita and Boiger, 2014), situating these dynamics within the Austrian healthcare system is essential for understanding how functionality became both an adaptive resource and an institutional expectation during the pandemic.

Methods

This qualitative study formed part of a cross-faculty project at Sigmund Freud University in Vienna, Austria, investigating the burden on healthcare workers during the COVID-19 pandemic. The present paper reports the qualitative strand, which employed deep-structure hermeneutics to examine crisis management within hospital care. Data were collected across several COVID-19 wards—including intensive-care units—within a public hospital in Vienna; the collaborating hospital remains unnamed to preserve pseudonymity.

Participants and recruitment

Recruitment occurred through a hospital-wide announcement distributed via the nursing office and routine staff meetings. Due to lockdowns and infection control measures, interviews commenced in summer 2021. Thirteen nursing professionals from the hospital’s various COVID-19 wards volunteered to participate and were interviewed.

Data collection

Participants received written study information and provided informed consent. A semi-structured interview guide invited reflections on perceived burdens, coping strategies, and recommendations for future crises. Following an ethics-of-care stance, prompts avoided probing potentially overwhelming experiences. Whenever possible, interviews were conducted by two trained interviewers; this was the case for 11 of the 13 interviews. On one interview day, two interviews were conducted by a single interviewer due to unforeseen circumstances. A comparison with the remaining dataset revealed no discernible differences in thematic depth, narrative structure, or the quality of scenic material, aside from a slightly increased organisational load for the interviewer.

Interviews took place in a private room within a hospital administrative building to ensure discretion and on-site anonymity, and were audio-recorded, transcribed verbatim, and pseudonymised. They were conducted in German, and all excerpts cited in the manuscript were translated into English for publication.

Ethics

The study received favourable ethics approval from Sigmund Freud University and the cooperating hospital. Participation was voluntary, and all procedures complied with institutional and GDPR standards.

Analytic approach: Deep-structure hermeneutics

Analysis followed deep-structure hermeneutics (Tiefenhermeneutik) as developed in psychoanalytic social psychology (Lorenzer, 1986, 2006) and later methodological elaborations (König, 2004; König et al., 2020; Wimmer et al., 2023). The method distinguishes between manifest content (culturally coded narration) and latent meaning, accessible through scenic understanding—that is, the embodied, affective dimension of interaction. Interpretations were produced in moderated group sessions, which attended to resonance, irritation, and intersubjective negotiation as epistemic tools.

Interpretations were conducted in several group constellations throughout the broader project. These included sessions with the core research team, consisting of researchers trained in qualitative methodology, psychodynamic theory, and deep-structure hermeneutics, as well as mixed-level interpretation groups involving students of psychotherapy and psychology from Sigmund Freud University (Vienna, Linz, Berlin). In addition, the focal interview for the present single-case analysis was interpreted in a dedicated session at the Vienna Autumn School of Methods (VASOM) 2021, an academic workshop that brings together participants from different career stages—including students, early-career researchers, and senior scholars—to practice and discuss deep-structure hermeneutic interpretation. This session was moderated by an experienced methodologist.

All interpretation groups consisted solely of researchers or research trainees; participants of the study were not involved in the analytic process. The combination of disciplinary backgrounds (psychotherapy science, psychology, education, and sociology) and career stages enriched the interpretive process by bringing multiple perspectives into dialogue.

Procedure

Transcripts were distributed in advance. Each interpretation session followed a condensed, standardised sequence:

1. Free associations under evenly suspended attention;

2. Open interpretive discussion of tensions, silences, and affective shifts, with vigilance against premature consensus;

3. Return to the text through targeted re-reading aloud to ground interpretations in form and language;

4. Scene-based memos articulating manifest and latent layers and linking micro-experiences to team, organisational, and societal references;

5. Case synthesis consolidating insights while preserving ambiguity and restricting claims to the focal interview.

Trustworthiness and reflexivity

Credibility and interpretive depth were enhanced through analyses conducted in multiple constellations, including student groups, the core research team, and expert sessions. This plurality of interpretive voices enabled systematic scrutiny of resonances and contradictions and aligns with established qualitative criteria of credibility, transferability, and reflexivity (Lincoln and Guba, 1985). At the same time, such heterogeneity required sustained reflexive attention to how researchers’ own professional socialisation and institutional positioning might shape interpretive processes.

In line with the epistemological assumptions of deep-structure hermeneutics, the research team engaged in explicit reflexive positioning. The core researchers were trained in qualitative methodology, psychodynamic theory, and hermeneutic interpretation and were institutionally situated within psychotherapy science, psychology, education, and sociology. We acknowledge that these disciplinary backgrounds—and our proximity to clinical and academic contexts—may influence interpretive resonance and the recognition of latent meaning structures. To mitigate this, analyses were conducted in intentionally heterogeneous constellations across different career stages (students, early-career researchers, senior scholars), with expert moderation guiding the interrogation of our own assumptions. This diversity of perspectives, combined with the method’s emphasis on irritation, contradiction, and scenic grounding, served as a reflexive counterweight to potential interpretive bias.

Case selection

For this article, one interview was purposively selected as a case vignette. In deep-structure hermeneutics, latent dynamics become accessible through detailed scenic analysis of individual texts (König et al., 2020; Lorenzer, 1986). The chosen case was analytically rich: the interviewee held a leadership role in an intensive-care unit, bridging micro- (self/affect regulation), meso- (team coordination), and macro- (institutional/societal) dynamics. The transcript displayed pronounced positivity with swiftly downplayed criticism, providing a clear entry point for scenic interpretation. The single-case analysis illustrates how deep-structure hermeneutics can reveal latent meaning structures within institutional narratives. Rather than aiming to represent all healthcare professionals, the purpose is to reconstruct cultural and institutional meaning structures as they become visible in this analytically rich interview.

Results

The findings are presented in two steps: first, the manifest content of the selected interview is outlined to provide a descriptive account of the participant’s narrative. In a second step, the latent content is analysed using deep-structure hermeneutics, highlighting unconscious dynamics and scenic meanings that shape the account. The analysis is structured into three main themes, followed by a meta-level interpretation linking the individual case to broader societal and institutional contexts.

Manifest content—Interview description

The interviewee is a woman in a leadership role heading an intensive care unit with a team. Married and without children, she described herself as someone who adhered rigorously to the lockdown regulations. While convinced of their necessity, she also admitted that at times the abundance of rules and restrictions felt overwhelming. Contact with friends and family was reduced to a minimum, which gave rise to frustration, sadness, and periods of psychological strain. In contrast, when speaking about her professional responsibilities, she repeatedly emphasised that everything was manageable and could be approached with a positive mindset.

The interview begins with the assertion that no significant burden is being felt. There is a crisis, but the professional mandate makes the situation manageable. Everything is running smoothly, and a positive attitude and team cohesion are emphasised as crucial resources:

When support is available from all sides or when you can always ask questions and actively seek help, it was personally not a problem for me, so I found it really not burdensome in this form; I found everything else happening around me outside of work to be more burdensome. (Lines 52–56)

Conditions for successful work are described as being in place. With good communication, new team members can integrate easily. Organisation is identified as the essential and central element:

These things, you know, that’s something different. No, everything else, everything that can be organised, I want to see positively, knowing that not everything is positive, yes, who wishes for something like that. Everything that I have no influence over and that is difficult to organize is actually what worries me more. (Lines 433–435)

Overall, the interview highlights that a positive mindset and approach to the crisis are central. No deficits are perceived in the professional domain, as this area is handled competently. Difficulties are described as stemming more from external influences such as societal attitudes, as well as economic and global conditions. Concerns about the younger generation and how they are coping with the events are raised, illustrated for example by her reflections on her niece. These worries are mentioned alongside the challenges of distancing from family and the social isolation of employees. Burdens and challenges are framed as manageable through a constructive work attitude.

At the same time, however, her account is not entirely consistent. While she repeatedly stresses positivity and manageability, she also hints at difficulties such as limited resources and overwhelming regulations. Yet these critical aspects are never explored further but are quickly overshadowed by a return to constructive and optimistic framing, leaving a tension and a certain irritation between voiced concerns and the insistence on a positive outlook.

Analysis of latent content

The presentation of the latent content is structured to elucidate the key elements from the analysis, providing insights into the underlying dynamics. The analysis begins with (1) “Positive Rhetoric as a Shield Against Helplessness,” highlighting the strong positive attitude portrayed as a means to ensure smooth functioning. This is followed by (2) “Splitting of Professional Work and Private Emotional Self to Create Structure and Security,” emphasising that it is not just positive rhetoric that is decisive, but also the division between professional and private life. The third part of the latent analysis, (3) “Loss of Control and the Overflow of the Crisis into the Private Sphere,” reveals the helplessness and instability experienced outside of work. The analysis concludes with a meta-level discussion, (4) “Meta-level Analysis of the Challenges in the Healthcare Sector—Societal Role—Functionality as Security Against a Global Threat and the Conscious Reflection on Effort and Self-Sacrifice to Create Personal (Freedom and Care) Spaces,” which highlights the societal context and the impact of these functional processes. While this protective mechanism is advantageous during times of crisis, it appears that, in the long term, there is a need for spaces where non-functioning in a protected environment is permissible.

Positive rhetoric as a shield against helplessness

In the process of interpreting the interview, it becomes evident that the positive narrative serves as a defence mechanism against feelings of helplessness. The arguments seem forced and allow no room for objection. The interviewer’s questions about stressors outside of work are interrupted before anything burdensome can be addressed. The start of the subsequent statement with “Look” suggests that something unchangeable and based on facts is about to be presented.

Totally, look, it’s always the case that we seem to want to go back to the way things were, no, we don’t wish for that, but the question is always, how do you deal with a crisis? And my approach is that a lot of it is about, um, I try to be a positive person and focus on the positive because I can’t let myself get dragged down; otherwise, I have to start over again to pick myself up, and that’s just a waste of time and energy that I don’t need in my life, and I think, for me, it’s a fundamental attitude. (Lines 116–125)

Throughout the interview, there are moments where the interviewee tries to maintain control of the conversation with phrases like “Look” or “You know.” It gives the impression that the positive attitude must not be shaken, and the inviolability of this portrayal is safeguarded by the facts presented by an expert. However, the statements themselves already hint at underlying doubts.

These things, you know, that’s something different. No, everything else, everything that can be organized, I want to see positively, knowing that not everything is positive, yes, who wishes for that. (Lines 433–434)

The crisis itself can clearly be seen as not positive, but more important is how it is handled. Despite this, the interviewee insists on viewing the circumstances and the approach to coping with them positively. The use of the word “want” indicates a conscious effort to maintain a positive outlook. There is frequent mention of trying. The statements create some dissonance, as both the system and the circumstances are criticised in the same breath. There are things that could be troubling, things that could pull one down. These issues are so close that they are woven into positive comments without being directly named.

At some points in the interview, issues are named directly without compromising the veneer of positivity. In contrast to the overall positive attitude, words like “terrible,” “catastrophe,” “bad,” and similar terms are often used.

It’s been a year and a half or almost a year and a half of an incredible dry spell, with a lot of work done, and I don’t just mean the nursing staff, but wherever you look outside, everyone had to work hard, even those who couldn’t work or who wanted to work, it’s, I hope, I really hope I’m wrong because, as I said, socially, economically, and in the healthcare system, it’s just a catastrophe, yes. (Lines 379–384)

And whether things run better tomorrow, and we suddenly have 20% more, I have no influence over that; it is what it is. And I don’t need to worry about it beforehand, for me, it’s about protection, the staff, how they are doing, that’s essentially the most important thing to me, and the patients are important, too, but if I don’t have staff, and if my team is struggling or if we are struggling, it’s going to be very difficult. [. . .] I think we simply need, what we need, we need, look, basically, we just need more staff, wherever you look, that’s just how it is. (Lines 358–378)

The positive fundamental attitude that everything is running smoothly and there are no burdens acts as a mantra that must be repeated to internalise it. Unchangeable situations, where there is no room for direct action, are wrapped in a protective layer of positivity. This professional positive attitude creates a manageable framework for action that envelops and thus represses feelings of helplessness.

[. . .] the situation is now here, and it has to be managed, so what do we need to work through, or who do we need to support, or what do I need to manage it well without talking about survival, yes. That’s how I see it. (Lines 134–138)

The ambivalence lies in the fact that it seems easy and seamless on the outside and is intended to appear that way. At the same time, there is a need to communicate the effort it takes to keep the system running, which is highlighted by the mention of survival. However, this positive rhetoric as a safeguard applies only to the professional sphere. It is mentioned several times that areas outside of the professional role are perceived as significantly more challenging. Follow-up questions are not possible, as they are repeatedly interrupted or overshadowed by arguments that reinforce the positive fundamental attitude.

Splitting of professional work and private emotional self to create structure and security

The interview reveals a clear division between the work sphere and the private sphere. Work is manageable, and anything not anchored within the professional framework is difficult. Although the interview does not explicitly elaborate on what is considered difficult, it becomes clear that stress in the private sphere signifies a loss of control.

[. . .] now at work, at work we could handle everything. (Line 60)

In the work setting and within the professional framework, there is a sense of security that does not exist in the same way in private life.

Uh yes, and so for me personally, for me, only for me personally, it wasn’t that burdensome; the other things were burdensome, but at least at work, we still had social contacts. (Lines 12–14)

Within the professional role in an institutional setting, there is a foundation of order. The corresponding guidelines and structures provide security for managing the professional, structured environment.

[. . .] but I don’t want to downplay the work, that it’s just work now, but a lot can be done structurally and organisationally when there’s a good team, meaning all professional groups, and when we try to find common solutions. No one says every solution was good, but we reflect on it, look at how we move forward, what can be done, how can we improve, how can we find solutions. If something happens, it happens, and it must be dealt with and understood, perhaps in the group, and then we look for new solutions, new approaches, yes. (Lines 190–198)

Emotions have little space in the clinical setting. When they are mentioned, they are immediately denied, or the professional attitude is adopted, which closes off that space or encapsulates the emotional aspect in a static shell.

That may be a bit pragmatic, but when it comes to matters of the heart, and yes, if you ask me how my staff, who haven’t been home for two years, are doing, it’s terrible. It’s terrible, yes. We can’t change it. (Lines 199–203)

In this passage, the term “matters of the heart” is directly mentioned, acknowledging that the isolation of the lockdown was terrible. The emotional significance can be sensed through the repeated mention. However, the narrative abruptly stops here, as potential feelings of stress and helplessness, coupled with underlying emotions like fear or anger, might overwhelm. The pragmatic comment, “We can’t change it,” seals off the topic, preventing further exploration, either externally or internally. Thus, the professional rhetoric is practiced not only for others but also for oneself, to avoid jeopardising this sense of security.

The interview mentions the support available through supervision and notes that the team does not require it because everyone in the department is well-motivated. In this context, the interviewee speaks of good team cohesion, which contributes to the absence of stress on the ward (Lines 205–218). Professional rhetoric is thus applied on a micro-level, both outwardly and inwardly, but also on a meso-level, as it becomes clear that the self and identification with the work team and the corresponding security extend to the entire department.

In subsequent sequences, it is mentioned that it was indeed challenging for the staff to deal with the constant changes (Lines 237–242). This recurring shift between “not burdensome” and “burdensome” creates a sense of dissonance. Everything is enveloped in a pragmatism consistent with professional rhetoric, verbalised through terms like thinking, understanding, and reflecting as a means to finding solutions.

 And that is a pragmatic division of tasks, and everyone does what they do best, yes. (Lines 263–264)

It is about doing, about functioning—and in another crisis situation, it will be handled the same way until the crisis is over (Lines 290–291). There is no need to think about it; it is simply done (Lines 349–350).

And the questioning of what happens tomorrow and the day after tomorrow, I don’t need to think about what happens tomorrow and the day after tomorrow. For me, the most important thing is, do I have a team, is the roster filled, and do I have the ability to protect my team, and do they have the opportunity to come to us when they need to speak up. . . yes, that’s the only thing. (Lines 353–357)

The note that the team always has the opportunity to “speak up” seems to refer less to sharing opinions or engaging in an emotional, relationship-oriented exchange, and more to a chance to vent frustrations. This brief release functions as a form of catharsis, serving primarily to restore functionality rather than to open space for deeper reflection. Emotionality predominantly arises in the private sphere and carries with it seeds of confusion, fear, and helplessness. These moments are immediately followed by narratives about work, which is experienced as structured, manageable and therefore stabilising. In this sense, the secure professional role functions almost like protective gear: something that can be put on and taken off, practiced over many years, and relied upon to provide stability. When “worn correctly,” it creates a psychological and institutional shield that enables professionals to maintain composure and remain operational.

This fundamental attitude doesn’t come overnight, now we have COVID and now we’re in a good mood, it’s not about that, you can’t sugarcoat it either, it’s just a special situation, there are also situations with the protective clothing. Personally, it didn’t bother me, I’m used to putting it on and taking it off continuously. Of course, it’s a new situation for the team, we don’t even need to discuss that, yes, that’s how it is. (Lines 126–131)

Within this framework, any trauma can be held and endured. References are repeatedly made to the fact that, especially in an intensive care unit, it’s about life and death, and that’s a daily occurrence. People in life-threatening situations must be cared for and treated, and not everyone survives the physical trauma. The emotional trauma is not named and remains subtly present. However, the conditions during COVID times were particularly challenging.

Yes, normal life would be nice, normal work, because what is burdensome is that the patients’ stays are incredibly short, yes. And that’s just with the, that’s probably, for me personally, that was the big challenge, um, finding ways that are difficult, um, there’s a time limit, um, how long you should stay with positive patients to avoid infection. Yes, so the protective clothing and such wasn’t a problem for me, so this social contact, this interaction with patients looks completely different, of course, that’s definitely missing, and that was the challenge, especially for the team, but also for us, of course, yes. (Lines 76–86)

The team and the organisation provide protection (Lines 358–364) against emotional trauma. It is a realm that is safe because it is part of the normal routine and professional duties.

And still, you stand there and so much is changing, and it does so much to you, but we didn’t see it, as long as we can organize it, as long as there are possibilities, I am calm and relaxed. It only gets bad when it becomes difficult, when it’s not just about being able to organize, that would already be a major concern, but fortunately, that’s not the case. (Lines 446–450)

Loss of control and the overflow of the crisis into the private sphere

The real threat must be warded off. With protective clothing and in the professional role, it is possible to dissociate and thus protect the inner early childhood part of oneself. This ability is socially recognised and essential for the functioning of the healthcare system. Without this ability, the healthcare system would face collapse. To remain functional, the crisis must not penetrate the professional domain. The protective clothing (professional role and framework) keeps the viral disease (crisis) away from the body (emotions), preventing it from becoming psychologically overwhelming.

Outside of work, where there is no control, no organisation, and no protective framework, emotional turbulence prevails. Before the COVID-19 pandemic, crises were a natural part of professional life, managed through the professional role. However, in the private sphere, the crisis was not experienced. With the COVID measures, this logic shifted, and suddenly, a crisis had to be dealt with in the private sphere, where the usual coping mechanisms of dissociation did not work.

The defence mechanisms are clearly visible in the interview. Although it was pre-determined not to probe deeply, there was hardly an opportunity to ask open-ended questions where the interviewee could decide how much to disclose. It took four attempts by the interviewer to even ask how the interviewee was dealing with the private situation or the risk of infecting others. None of the questions led to a narrative about the burden in the private sphere. Either the questions were not fully formulated, or there was a neutral answer devoid of emotional content.

Look, for us, it was like this: we saw my parents every day, we passed by, we went for walks, went shopping and for walks, waved to them once, then talked to them again, but it’s not the same; it’s not normal life. (Lines 303–306)

In this response, there is no trace of the massive threat that is frequently mentioned. In the deep hermeneutic group, including the interviewer herself, it was forgotten that the question was asked in the interview, as the interviewer also engaged in the defence mechanism. The discussion group repeatedly doubted whether the interviewee actually felt any burden. It was only upon deeper analysis that it was noticed that the interviewee never referred to herself. She spoke about others when discussing burdens, and when she did mention herself, it was only in the context of being there for others. How she personally felt was not mentioned and could only be interpreted through her projections onto others. These projections also occur in the private sphere, where others are helpless, afraid, and unable to cope with the crisis. Examples include panic buying and the fear of supermarket employees. These sequences are emotionally charged, as suggested by the fragmented and confusing narration. The stories conclude disjointedly with the professional framework, as a means of restoring security.

The worst situation was certainly when it all started, when all the shops were completely full to the back, and the cashiers, I mean, one of them was in tears and so scared, wearing a mask, yes, I find that concerning. So, that affects me emotionally, but I don’t want to downplay the work, that it’s just work now, but a lot can be done structurally and organisationally when there’s a good team [. . .]. (Lines 186–192)

The professional role is akin to a higher calling, whose essence is caring for others. The professional code of conduct spills over into the private sphere, where an attempt is made to apply the same security mechanisms. In the work context, it means that people die—in the private sphere, this cannot be allowed. Being a threat oneself is impossible within the internal structure and leads to a state of conflict. The direct question about concerns in the private environment is answered in a socially adjusted and softened manner. The actual horror is revealed in other statements, especially in the situation with the niece.

[. . .] my niece, who’s two, well, she’s also my godchild, who wanted nothing to do with us until we washed our hands, even though I had disinfected them beforehand. She dressed herself at two years old, getting ready to go outside in summer with a hat and scarf—I think these are things that concern me more, what it actually does socially, what it actually does socioculturally, and what it does to oneself. (Lines 162–165)

A sense of distress is perceptible in this statement. It concerns a very close relationship, yet broad conclusions are drawn, and inferences are made about sociocultural influences. What is hurtful is that despite following all the rules, there is still rejection. In isolation, there is no physical contact, no closeness, no warmth. Even a distanced and formal handshake becomes a taboo.

I didn’t hug my mother for a year, yes, all those physicalities, yes, also the hugging and being close together, that’s just missing, and it affects social life, and it also affects society; I don’t even want to start on the economic side, it’s a catastrophe, what’s actually happening, and what’s still to come, [. . .]. (Lines 154–158)

Meetings with friends now only happen at a distance, and a milestone birthday is celebrated over a video chat. As in professional rhetoric, a pragmatic “But that’s just how it is, and it’s all just a matter of attitude” (Lines 327–330; 331–335; 438–450) is employed here. An unfolding alienation becomes perceptible through the ongoing distancing. It is mentioned that during meetings with friends, interest wanes after half an hour, and the flow of conversation breaks down (Lines 438–445). This fear of distance and inner isolation is also expressed through a shift onto patients.

I don’t know what it’s like to be old, really old, and maybe in need of care and then not getting any visits, and everyone only dies once, and I think it’s just terrible, what’s happened there, [. . .] (Lines 171–173)

The phrase “everyone only dies once” seems paradoxical, as the usual saying is “you only live once.” The focus is on death and dying, creating a sense of apocalyptic fear. Along with distancing, there are multiple mentions of social, sociocultural, economic, and global catastrophes threatening everyone’s life.

And about the environment, how we’re going to survive all this mask waste and plastic and whatever, I don’t want to say, I’m actually glad I’m old, but I am glad I’m old because it’s all madness, but that’s not why we’re sitting here, is it? (Lines 454–457)

Personal mortality is not directly mentioned, only hinted at. The aggression, usually covered by diplomatic professional rhetoric, is briefly allowed to break through with the term “mask waste.” Directly and without disguise, the externalised societal threat can be named on the macro level. This is immediately followed by the wish not to have to experience it. This suggests that there is no adequate knowledge of how to cope with crises in the private sphere. To neutralise this “outburst,” the statement is concluded with “but that’s not why we’re sitting here.”

The existing helplessness only becomes apparent in the deeper hermeneutic discussion. Within the interpretation group, questions were raised as to why the behaviour of the niece could not be interpreted as childish play and why there is no sense of agency concerning environmental protection and climate change. The feeling of being able to do something makes a crisis situation more manageable. The interviewee achieves this in her professional role, but not in the private sphere. The perceived powerlessness is made clear through statements like: “But none of us have any control over that. Try going plastic-free shopping, it’s not possible, yes” (Lines 460–461).

Helplessness and inaction leave only one option: escape into the professional framework of work, where there are possibilities for action and thus control. The identifications and projections allow the self to perceive colleagues with the same professional ethos as introjected and “safe harbour” figures. In this “we” context, secure closeness can be established through professionalisation. In the work context, the self merges with the professional collective, while the perceived threat exists outside and must be warded off.

Look, it’s difficult when you look at England, where they want to open everything up and without anything, I think the transparency is difficult, knowing that even with vaccination you can still get infected. Of course, some people believe they are protected from everything, yes, and if you say, 90% is left, 10% remains, and I think it’s important to know that everyone needs—I would wish for more personal responsibility in society, that has nothing to do with work, personal responsibility. (Lines 409–415)

The professional framework is completely secure and provides a structure within which one can move comfortably. In contrast, there seem to be no resources, basic trust (also in relation to society), or containment possibilities for crises in the private sphere. The paranoid position points to early childhood elements that can temporarily make a mature structure permeable. Since the crisis in the private sphere does not correspond to the usual previous normality, it is perceived as absurd and not real: “That also shows that we haven’t arrived in reality, that we’re not living a normal life” (Lines 341–343).

Meta-level analysis of the challenges in the healthcare sector—societal role—functionality as security against a global threat and the conscious reflection on effort and self-sacrifice to create personal (freedom and care) spaces

On a societal level, the positive rhetoric as a means of security gains relevance when individual burdens in the healthcare sector are denied, warded off, and repressed. On a macro-social level, the overload in the healthcare system was made visible through numerous media reports and organised public protests, leading to a recognition of the enormous efforts of medical professionals.

In contrast, such recognition was often not possible on the micro- and meso-social levels. In interviews, several individuals stated that they were not personally burdened and were able to cope well with the crisis. Here, the focus was more on the potential personal failure, associated with shame and the need to protect one’s own stability. The dilemma between ensuring and maintaining functionality during a crisis leaves little room for a deeper emotional experience of individual needs. Such an opening could precipitate a breakdown of psychic stability, which is associated with an unconscious fear of annihilation.

Work becomes a stabilising internal reference point that provides a sense of security, while everything outside of work appears unpredictable and emotionally overwhelming, and is therefore warded off. Since work is organised, rational, and structured, feelings of burden seem to have no place.

A failure of medical personnel during a global health crisis would have far-reaching consequences for system stability. The effort to ignore personal needs and to prioritise public service demands considerable psychological strain.

I believe that in a society, everyone has to contribute what they can, and whatever is possible, with all rights and obligations, of course also obligations, but also that legal norms should be guaranteed, especially in a democracy. (Lines 419–422)

Personal feelings such as exhaustion, fear, grief, anger, or despair are thus set aside or even repressed. The impression should not be given that those who help might need help themselves. In this conflicted dilemma, the question arises as to how a functioning and stable healthcare system can be maintained while also considering the individual needs of the employees. Societal expectations often appear to privilege system continuity over individual wellbeing.

During an acute crisis, this may be necessary, similar to a traumatic emergency situation where action must be taken first, while emotions can be processed later. However, after every crisis, there comes a phase of regeneration and processing. The healthcare system needs time to recover and to process the existing trauma so that employees can regain their personal functionality. This requires spaces where they do not have to “function” professionally and where they can process physical and emotional strain.

These internal spaces and the external conditions for them must be individually tailored. This requires the awareness that such spaces are needed at all. At this meta-analytic level, these reflections move beyond the manifest material and represent theoretically informed implications derived from the latent dynamics reconstructed in the analysis. Yet the interpretive material also shows that as long as work is experienced as a primary zone of stability and the professional role is maintained out of fear, this reflection often does not take place.

Therefore, it is crucial that clinical institutions within the healthcare system provide opportunities such as supervision for medical personnel. Although this offer is sometimes not seen as necessary by employees (Lines 209–213), it helps to make the issue visible and to maintain public discourse. External offers can increase accessibility and avoid stigmatisation.

In addition to such institutional support measures, informal opportunities must also be created that do not directly relate to work-related stress but address individual needs.

Discussion

As the preceding deep-structure hermeneutic analysis revealed, the interviewed healthcare workers tended to describe the disruptions and uncertainties of their daily routines during the COVID-19 pandemic as only minimally burdensome on a manifest level. While this pattern appeared across the broader dataset, the focal case illustrates these dynamics with particular clarity and density. These insights do not claim representativeness for all healthcare professions but illustrate how deep-structure hermeneutic analysis can reveal latent culturally and institutionally embedded meaning structures that shape how burden and functionality are narrated in a specific context. In line with the logic of deep-structure hermeneutics, we use “functionality” as an empirically grounded sensitising concept that captures a recurrent latent dynamic in the material rather than a new psychometric construct. Within this interpretive frame, the interviewee’s emphasis on teamwork, a disciplined professional stance, and consistently positive reframing emerges as a strategy for managing uncertainty and minimising the articulation of burden. Yet this surface resilience stands in marked contrast to the extensive evidence documenting severe psychological distress among healthcare personnel during the pandemic (Brune et al., 2024; Duden et al., 2023; Eichenberg et al., 2024; Georgiadou et al., 2023; Krishnamoorthy et al., 2020; Lee et al., 2023; Powell et al., 2024; Schulze and Holmberg, 2021; Skoda et al., 2020; Smeltzer et al., 2022). Begerow et al. (2020), for instance, vividly depict the overload, fear, and moral conflicts of German intensive-care nurses—experiences almost absent in our participants’ narratives. This contradiction between surface-level resilience and latent vulnerability forms the analytical core of the present interpretation.

Only through deep-structure hermeneutics could these latent dynamics be uncovered. The analysis revealed that healthcare workers did experience high stress, yet could not articulate it: acknowledging helplessness threatened both emotional stability and the fragile functionality on which hospital operations depended. From a psychodynamic perspective, this suppression of affect represents an unconscious defence mechanism aimed at preserving ego stability and institutional order. The uncritical internalisation of institutional and societal expectations—helping others, maintaining hospital function, and supporting colleagues—creates a pressure to function that leaves little space for self-care or emotional processing. Such expectations, shaped by professional ethics, normative ideals of caregiving, and institutionalised notions of responsibility, reinforce an ethos of invulnerability (Löber, 2012; Schmidt, 2015). Einboden (2020) aptly describes this as a “hero discourse” that idealises self-sacrifice while obscuring its psychological cost. Within hospitals, where a “Culture of Blame” often prevails (Löber, 2012), dysfunctionality is framed as a defect to be corrected rather than a sign of human limitation. These cultural and organisational matrices demand smooth functioning and make the acknowledgement of weakness nearly impossible—especially under crisis conditions. While discourses of positivity may also resonate with broader cultural narratives about coping, the dynamics reconstructed here appear primarily rooted in institutional pressures and psychodynamic defence rather than in a wider therapeutic habitus. The deep-structure hermeneutic findings further illustrate how workers unconsciously regulate these tensions. Emotional distancing serves as a key defence: feelings of anger, sadness, or fear are held at bay, preventing confrontation with one’s own helplessness (Badger, 2005; Breinbauer, 2020; Weidner, 2004). Strict adherence to professional roles and routines functions as defensive rational functionalism (Badger, 2005; Doppelfeld, 2013; Weidner, 2004). Mackintosh (2007) described this as the creation of a “work persona,” marked by emotional withdrawal and a division between professional and private selves. Such professional distancing is indispensable for those continually confronted with suffering, providing stability and preventing secondary traumatisation or empathy fatigue (Doppelfeld, 2013). At the same time, collegial solidarity and shared purpose can foster belonging and resilience (Lackman Zeman et al., 2023).

Yet what sustains functionality in crisis may become costly over time. Persistent pressure, high expectations, and the moral imperative to endure can lead to exhaustion, burnout, and depersonalisation (Doppelfeld, 2013; Schmidt, 2015; Weigl et al., 2016). These outcomes contribute to absenteeism and attrition, deepening the current workforce shortage—arguably a delayed consequence of pandemic strain (Falatah, 2021; Tolksdorf et al., 2022).

However, functionality must also be understood as a vital adaptive resource. In moments of collective threat, maintaining structure and efficiency is not only protective for individuals but also crucial for preventing systemic collapse. McHugh et al. (2025) demonstrated that wellbeing among healthcare professionals can be sustained when functionality is embedded in purpose, relatedness, and a shared sense of meaning. From this perspective, functioning is not mere compliance but a capability—a way of preserving agency and dignity amid crisis. The present study corroborates this view: teamwork, professional identity, and shared commitment enabled participants to remain effective even under extreme pressure.

Our deep-structure hermeneutic analysis, however, extends this understanding. It reveals that the very mechanisms sustaining functionality can simultaneously serve as unconscious defences against overwhelming affect and vulnerability. Functioning thus becomes both a resource and a defence, a means of survival that protects the psyche by transforming emotional turbulence into disciplined action. Yet this transformation comes at a cost: it suppresses the expression of fear, grief, and exhaustion and can delay emotional processing long after the crisis subsides. Recognising this ambivalence raises the question of how supportive environments might be structured at times when emotional expression is constrained by the need to remain functional. While the empirical material does not explicitly articulate a need for such spaces, the deep-structure hermeneutic interpretation highlights how the imperative to remain functional can restrict emotional processing. We therefore conceptually propose “spaces of non-functioning” to denote environments in which the normative imperative to perform is temporarily suspended. The proposal for “spaces of non-functioning” therefore emerges as a theoretically informed implication for future research and institutional practice, grounded in the psychodynamic mechanisms identified in the analysis. Such spaces cannot simply be supervisory or therapeutic contexts, which may be perceived as threatening to the fragile balance of professional control. Instead, they must be informal, low-threshold environments that invite rest, spontaneity, and unstructured reflection—spaces where healthcare workers can exist outside their roles without the obligation to be resilient. These moments of non-functioning do not undermine institutional stability; rather, they restore it by integrating human vulnerability into the fabric of care.

Safeguarding healthcare workers and ensuring system resilience therefore require institutional reflexivity. Hospitals must provide social and reflective spaces—including but not limited to supervision and coaching—where professionals can acknowledge vulnerability without stigma and critically examine role expectations and coping strategies (Doppelfeld, 2013). Establishing a constructive error culture is equally vital for transforming the “pressure to function” into a space of reflective functionality, where human fallibility is integrated rather than denied. Ultimately, this study underscores that sustainable care depends not on heroic endurance but on relational wellbeing—the capacity to remain functional through reflection, connection, and a deep-structure awareness of shared vulnerability.

Conclusion

This study offers a deep-structure hermeneutic reconstruction of how healthcare professionals working on COVID-19 wards sustained functionality under conditions of profound uncertainty and strain. The findings show that institutional expectations, professional identity, and unconscious defence mechanisms interact to preserve stability while simultaneously constraining emotional expression. Functionality emerges not as a fixed psychological trait but as a culturally and institutionally situated coping mode with both protective and restrictive dimensions.

By highlighting this ambivalence, the study contributes to a more differentiated understanding of resilience in healthcare and underscores the need for institutional cultures that recognise the psychological cost of sustained performance. The proposal of “spaces of non-functioning” is introduced here as an invitation for further reflection on how contexts that temporarily suspend performance demands might support emotional processing and longer-term wellbeing. Ultimately, the analysis suggests that sustainable care depends not on heroic endurance, but on institutional reflexivity and the integration of vulnerability into the fabric of professional life.

Limitations

While the in-depth analysis of a single case yields valuable insights into latent meaning structures, it necessarily restricts the scope of generalisation. Further studies are needed to examine how coping strategies of healthcare workers unfold across different organisational contexts and cultures. It will also be important to investigate more systematically how functionality operates as both a resource for stress regulation and a potential source of psychological strain. Although the acute COVID-19 pandemic has passed, future research should explore how such coping patterns persist, transform, or re-emerge in subsequent challenges to healthcare systems.

Additionally, the concept of “spaces of non-functioning” is introduced as a theoretically derived implication rather than an empirical finding. While grounded in the psychodynamic mechanisms reconstructed in the analysis, the potential effectiveness, acceptability, or practical implementation of such spaces cannot be established on the basis of the present data and requires further empirical investigation.

Finally, because emotional experience and regulation are shaped by sociocultural contexts (Mesquita and Boiger, 2014), the latent dynamics identified in this Austrian sample may not fully translate to healthcare systems with different cultural models of emotional coping.