MENTAL HEALTH AND W ORK: MEANI NGS AND LI MI TS OF THEORETI CAL MODELS
Josicelia Dum êt Fer nandes1 Crist ina M. M. Melo2 Mar ia Car olina C. M. Gusm ão3 Juliana Fer nandes4 An gélica Gu im ar ães5
Fer nandes JD, Melo CMM, Gusm ão MCCM, Fer nandes A, Guim ar ães A. Ment al healt h and w or k : m eanings and
lim it s of t heor et ical m odels. Rev Lat ino- am Enfer m agem 2006 set em br o- out ubr o; 14( 5) : 803- 11.
This t ext is a r evision of t he m ost im por t ant t heor et ical appr oaches t hat fundam ent t he st udies about Men t al Healt h an d Wor k , poin t in g t o t h e basic con cept s, cat egor ies of an aly ses an d r espect iv e lim it s. Th e obj ect ive is t o underline som e concept ions about t he t hem e, in t he at t em pt t o cont ribut e wit h a way t o face t he problem s, quest ions and difficult ies im posed by t he const ruct ion of t his obj ect of st udy. Thus, t he t ext is based on t h e cr it ical r ev iew of t h eor et ical par adigm s t h at pr edom in at e in st u dies abou t Men t al Healt h an d Wor k . Finally , it indicat es som e im por t ant t heor et ical quest ions about t he r elat ion bet w een m ent al healt h and w or k.
DESCRI PTORS: m ent al healt h; w or k ; st r ess; liv ing condit ions; healt h- disease pr ocess
SALUD MENTAL Y TRABAJO: SI GNI FI CADOS Y LÍ MI TES DE MODELOS TEÓRI COS
Est e t ex t o se const it uy e en una r ev isión de las pr incipales apr ox im aciones t eór icas que fundam ent an los est udios sobre la Salud Ment al y Trabaj o ( SMT) , apunt ando sus concept os básicos, cat egorías de análisis y respect ivos lím it es. Propone ofrecer algunos balizam ient os concept uáis acerca de la t em át ica SMT, en la t ent at iva de ecuacionar pr oblem as, cuest iones y desafíos colocados por la const r ucción del obj et o de est udio. Par a t al, el t ex t o se apoy a en la r ev isión cr ít ica de algunos par adigm as t eór icos pr edom inant es en los est udios acer ca de la SMT. Finaliza apunt ando cuest iones t eóricas im port ant es sobre las relaciones ent re la salud m ent al de los indiv iduos en su m undo de t r abaj o.
DESCRI PTORES: salud m ent al; t r abaj o; est r és; condiciones de v ida; pr oceso salud- enfer m edad
SAÚDE MENTAL E TRABALHO: SI GNI FI CADOS E LI MI TES DE MODELOS TEÓRI COS
Est e t ex t o se const it ui em r ev isão das pr incipais abor dagens t eór icas que fundam ent am os est udos sobr e Saúde Ment al e Tr abalho ( SMT) , apont ando seus conceit os básicos, cat egor ias de análise e r espect iv os lim it es. Propõe- se a oferecer alguns balizam ent os conceit uais acerca da t em át ica SMT, na t ent at iva de equacionar pr oblem as, quest ões e desafios im post os pela const r ução dest e obj et o de est udo. Par a isso, o t ex t o apóia- se na r ev isão cr ít ica de alguns par adigm as t eór icos pr edom inant es nos est udos sobr e a SMT. Finaliza apont ando quest ões t eór icas im por t ant es sobr e as r elações ent r e a saúde m ent al dos indiv íduos inser idos no m undo do t r ab alh o.
DESCRI TORES: saúde m ent al; t r abalho; est r esse; condições de v ida; pr ocesso saúde- doença
1
Full Professor, PhD in Nursing, CNPq Research Product ivit y Grant Holder, e- m ail: dum et @ufba.br; 2 PhD in Public Healt h, Adj unct Profesor; 3 Undergraduat e st udent , CNPq Scient ific I nit iat ion Grant Holder. Bahia Federal Universit y School of Nursing; 4 Undergraduat e st udent , Bahia Federal Universit y Facult y of Medicine, I nst it ut ional Scient ific I nit iat ion Program Grant Holder - PI BI C/ UFBA; 5 Mast er’s st udent , Graduat e Program , Bahia Federal Universit y School of Nursing
I NTRODUCTI ON
T
his t heor et ical and ex plor at or y st udy aim s t o p o i n t o u t so m e co n ce p t u a l a sp e ct s a b o u t t h epr edom inant t heor et ical appr oaches t hat ex plain t he
int errelat ion bet ween Ment al Healt h and Work, indicat ing
t heir basic concept s, analyt ic cat egories and lim it s.
Ment al Healt h and Work ( MHW) is not a new,
but a v er y cur r ent t hem e. I t ent ails a cont r ov er sial
d iscu ssion ab ou t it s con cep t an d ap p licab ilit y. Th e
t hem e is not only inv olv ing, but ar ouses r eflect ions
about t he t heoret ical approaches t hat explain it , being
considered a process where aggressions t o t he m ent al
appar at us, or iginat ing fr om w or k , ar e confr ont ed by
t h e sou r ces of v it alit y an d h ealt h , r ep r esen t ed b y
individual and collect ive resist ance, in t he preservat ion
of w or ker s’ values and dignit y.
Work organizat ion has t urned int o a relevant
social in st an ce in t h e h ealt h - m en t al illn ess pr ocess.
This organizat ion exert s effect s on t he worker ’s body,
including t he m ent al apparat us, im posing a part icular
funct ioning m ode, a cert ain m odel in t he light of t he
d e m a n d s , c o n t e n t s a n d r e q u i r e m e n t s o f t h e
pr oduct ion m ode’s logic.
Th e m e n t a l a p p a r a t u s i s, t h e r e f o r e , t h e
p r i v i l e g e d l o c a t i o n w h e r e t h e e f f e c t s o f w o r k
or ganizat ion on t he indiv idual w ill be ex pr essed( 1).
The com plex it y of t he m ent al appar at us, in
t ur n, r equir es analy ses based on t heor et ical m odels
t hat can guide st udies aim ed at under st anding MHW,
adopt in g a con cr et e h ist or ical m an , locat ed in t im e
and space, as t he fundam ent al analy t ic cat egor y.
Researchers have faced difficult ies t o put t he
adopt ion of t his analy t ic cat egor y in pract ice. Wor
k-r el at ed m en t al d i sok-r d ek-r s, d esp i t e h i g h p k-r ev al en ce
r at es in t h e w or k in g popu lat ion , f r equ en t ly ar e n ot
recognized as such during clinical assessm ent s( 1). This
difficult y does not only derive from t he charact erist ics
o f m e n t a l d i s o r d e r s , o f t e n h i d d e n b y p h y s i c a l
sy m pt om s, but also fr om t he com plex it y inher ent in
t he t ask of clear ly defining t he associat ion bet w een
t hese disor der s and t he indiv idual’s w or k .
Alt hough workers’ m ent al healt h is not a new
i s s u e , s t u d i e s p r o v i d i n g a d e e p e r t h e o r e t i c a l
-con cept u al discu ssion abou t t h is t h em e, iden t if y in g
k now ledge and m et hodological inst r um ent s, ar e st ill
lack ing. This gap is accent uat ed in t he healt h ar ea,
w h i c h c o n t a i n s t h e o r e t i c a l - c o n c e p t u a l a n d
m et h o d o l o g i cal d i f f i cu l t i es r el at ed t o MHW. Th ese
include t he adopt ion of a t heor et ical- m et hodological
ax is t o guide t he analy sis of findings and, also, t he
adopt ion of diverse and even cont radict ory t heoret ical
p r em i ses i n o n e a n d t h e sa m e st u d y, p r esen t i n g
differ ent m ut ually conflict ing elem ent s in t he r esult s.
Anot her difficult y is t he use of exhaust ion, st ress and
su ffer in g as sy n on y m ou s t er m s.
I n Br azil, few appr oaches look at sit uat ions
and associat ions of workers’ m ent al suffering t hrough
a perspect ive t hat int egrat es psychological and social
d y n am ics w it h a p olit ical an aly sis. I m p or t an t w or k
p s y c h o p a t h o l o g y s t u d i e s( 2 - 7 ) f o c u s o n g r o u p s o f
p r ob lem s at t r ib u t ed t o w or k or g an izat ion , of f er in g
pr eciou s in f or m at ion an d an aly ses f or t h e st u dy of
w or k er s’ m en t al h ealt h an d su ffer in g. I n t h e h ealt h
area and m ore specifically in nursing, few st udies( 8- 10)
ex ist in t his appr oach.
I n view of t his lack of references for a m ore
t h o r o u g h t h eo r et i cal - co n cep t u al d i scu ssi o n o f t h e
relat ions bet ween m ent al healt h and work, t his art icle
aim s t o offer concept ual indicat ions of t he predom inant
t h eor et ical appr oach es in st u dies on MHW, poin t in g
o u t t h ei r b a si c co n cep t s, a n a l y t i c ca t eg o r i es a n d
r espect iv e lim it s, in t he at t em pt t o cont r ibut e t o t he
e q u a t i o n o f p r o b l e m s, q u e st i o n s a n d ch a l l e n g e s
im posed by t his ar ea. Ther efor e, t his paper is based
on t he crit ical review of som e t heoret ical m odels t hat
ar e pr edom inant in healt h st udies, w it hout any claim
on analy zing pr oduct ions in t his t hem e ar ea.
Next , we highlight t he m ain analyt ic branches
su p p or t in g h ealt h st u d ies on t h e r elat ion b et w een
m ent al healt h and w or k .
THEORETI CAL MODELS I N STUDI ES ON
MENTAL HEALTH AND W ORK
The m ain m odel current s explaining relat ions
bet w een m ent al healt h and w ork are t he exhaust ion, general living and work condit ions, st ress, ergonom ics
an d w or k psy ch opat h ology appr oach es.
Ex h au st ion appr oach
Th e an aly t ic br an ch of ex h au st ion is based on t h e con cept ion t h at adopt s t h e w or k pr ocess as
t h e f u n d a m en t a l el em en t f o r a n a l y si s( 1 1 - 1 2 ). Wo r k
process and work load are seen as analyt ic cat egories
in t he under st anding of t he biopsy chosocial aspect s
i n f l u e n ci n g t h e ( m e n t a l ) h e a l t h - d i se a se p r o ce ss,
int erdisciplinary area is ident ified, w hich analyzes t he
c o n n e c t i o n s b e t w e e n m e n t a l h e a l t h a n d w o r k ,
pr esent ing t he ex haust ion concept as t he int egr at iv e concept ual opt ion.
Ex h au st ion is con sid er ed t o b e t h e loss of act ual and/ or pot ent ial biological and m ent al capacit y,
t o t he ext ent t hat work t urned int o an act ivit y whose
ex h au st iv e com pon en t is m u ch m or e ef f ect iv e t h an
t he replacem ent of t his capacit y and t he developm ent
of w or ker pot ent ials( 13- 14).
Ment al exhaust ion is associat ed wit h t he im age of “ con su m ed m in d ”, j oin in g t h r ee ar eas: t h e f ir st
co v e r s cl i n i ca l p i ct u r e s r e l a t e d w i t h t h e o r g a n i c
e x h a u s t i o n o f t h e m i n d ( w h e t h e r t h r o u g h w o r k
accident s or t he act ion of t oxic product s) ; t he second
includes variat ions of “ indisposit ion”, including ( m ent al
and phy sical) fat igue; t he t hir d ident ifies ex haust ion
t hat influences w or ker ident it y, affect ing values and
beliefs t hat can hurt his dignit y and hope( 13).
Th e f ollow in g clin ical p r ob lem s or n eu r ot ic
syndrom es st and out , ident ified t hrough t he exhaust ion
a p p r o a c h : t h e b u r n o u t s y n d r o m e ; t h e c h r o n i c
( p a t h o l o g i c ) f a t i g u e s y n d r o m e ; p o s t - t r a u m a t i c ,
depr essiv e an d par an oid sy n dr om es( 1 5 ).
The exhaust ion and chronic fat igue syndrom e
cor r esponds t o t he fat igue accum ulat ed acr oss w or k
per iods of v ar iable dur at ion, w hich do not allow for
sufficient r ecov er y t hr ough sleep and r est . The m ain
charact erist ic is const ant physical and m ent al fat igue,
accom panied by sleep disor der s, t ir edness, ir r it abilit y
and discour agem ent( 15- 16).
Po s t - t r a u m a t i c n e u r o s i s i s m a r k e d b y
i r r i t a b i l i t y, a n g u i s h a n d e x a g g e r a t e d e m o t i o n a l
r eact ion s. Mor eov er, t h e in d iv id u al m en t ally r eliv es
t h e t r au m at ic scen e, accom pan ied by in disposit ion ,
s o m e t i m e s i n c l u d i n g s w e a t i n g a n d t a c h y c a r d i a .
Nig h t m ar es also r ep eat t h e t r au m a ev en t , m ar k ed
by sleep disor der s, ir r it abilit y and a st at e of t ension
wit h disrupt ions, as if t he person were in a perm anent
st at e of aler t ness( 17).
The par anoid sy ndr om e is a neur ot ic pict ur e
i n w h i c h s t r o n g f e e l i n g s o f i n s e c u r i t y d e v e l o p ,
ex p er ien cin g t h r eat in sit u at ion s w h er e p ot en t ially
persecut ory aspect s and pressures are ident ified, wit h
rigid cont rol devices. The great er t he waged worker’s
com m u n icat ion b ar r ier s an d isolat ion , t h e easier it
w i l l b eco m e f o r t h ese m a n i f est a t i o n s t o d ev el o p .
Man if est at ion s of p er secu t or y an x iet y can in t en sif y
t o t h e ex t en t of ser iou sly d ist u r b in g in t er p er son al
r e l a t i o n s a n d p e r f o r m a n ce . I n p a r a l l e l , d i f f e r e n t
degr ees of ir r it abilit y and, fr equent ly, sleep disor der s
m ay appear( 15).
Th e or ig in s, d ev elop m en t an d ev olu t ion of
depr essiv e sy ndr om es can be clear ly associat ed w it h
w or k si t u at i on s. Dep r essi on can m an i f est i t sel f i n
t y p i c a l a c u t e o r c h r o n i c s i t u a t i o n s ( s a d n e s s ,
ex p er i en ces o f l o ss o r f a i l u r e a n d l a ck o f h o p e) .
How ev er, w or k- associat ed depr essiv e pict u r es of t en
are not t ypical and are revealed in a subt le way, wit h
discouragem ent about life and t he fut ure as t he m ain
m anifest at ion( 15).
The underst anding of exhaust ion as a m ent al disorder fact or does not refer t o any isolat ed process
in part icular, but t o a set of biopsychic processes, and
is not necessarily relat ed t o irreversible processes. I t
is exact ly t his lack of specificit y of exhaust ion in MHW analy ses t hat lim it s t he aspect s of it s m easur em ent ,
t o t he ex t ent t hat t his st ar t s t o be r ealized t hr ough
si g n s a n d sy m p t o m s t h a t a r e n o t sp e ci f i c o f t h e
psy chopat hological pict ur e t he w or k er pr esent s.
Th er ef or e, st u dies adopt in g t h e ex h au st ion
appr oach t o ou t lin e t h e r elat ion bet w een w or k an d
( m ent al) healt h face difficult ies, as exhaust ion has t o
b e m e a s u r e d t h r o u g h n o n - s p e c i f i c s i g n s a n d
sy m pt om s, m an y of w h ich ar e cau sed by cou n t less
fact or s t hr oughout t he indiv iduals’ liv es.
Gener al liv ing and w or k condit ions appr oach
The general living and work condit ions or w ay of life m odel is based on t he concept ion t hat adopt s occupat ion as t he cent ral elem ent in t he underst anding
of t he ( m ent al) healt h- disease pr ocess. The concept
of occupat ion, underst ood on t he basis of individuals’
inser t ion in a giv en occupat ional st r uct ur e and labor
m ar k et , is consider ed of fundam ent al im por t ance t o
under st and differ ent iat ed ex posur e t o psy chic r isk s,
w h et h er in con t in u ed ex p osu r e t o a sp eci f i c w or k
p r o cess o r i n t h e m o b i l i t y b et w een d i st i n ct w o r k
pr ocesses( 1 8 ).
Th r o u g h t h i s a p p r o a c h , g e n e r a l l i v i n g
condit ions are visualized as analyt ic cat egories, in t he
u n d e r s t a n d i n g o f b i o p s y c h o s o c i a l a s p e c t s t h a t
in f lu en ce t h e ( m en t al) h ealt h - disease pr ocess. I t is
em phasized t hat t his process is m ediat ed, on t he one
hand, by fact ors associat ed w it h t he w ay of life and,
o n t h e o t h e r, b y t h e i n d i v i d u a l ’s i n se r t i o n i n t h e
occupat ional st r uct ur e( 18).
Occu p a t i o n - r e l a t e d p sy ch i c r i sk s a r e n o t
gen er al liv in g an d w or k con dit ion s t h e in div idu al is
ex posed t o. Ex posur e t o t he w or k pr ocess does not
h ap p en con t in u ou sly, w h at p r ev ails is t h e w or k er ’s
exposure t o different iat ed work processes. The healt h
sect or it self is m arked by a wide range of st ruct urally
het erogeneous occupat ions ( physician, nurse, nursing
au x iliar y, phy siot h er apist ) .
I n v iew of t h e div er sit y of occu pat ion s an d
t heir st ruct ural het erogeneit y, general work condit ions
occur at t he sam e t im e as problem s relat ed t o living
condit ions. Thus, a series of aspect s in t he work and
overwork sit uat ion can act t oget her in t he developm ent
of m ent al disorders, wit h several int errelat ed aspect s.
Thus, in t his analyt ic branch, aspect s relat ed
t o workers' m ent al healt h cannot be rest rict ed t o t he
iden t if icat ion , t o t h eir m er e in t en sit y, based on t h e
work burden relat ed t o each work process, but m ainly
need t o explain t he nat ure of t he m ent al risks specific
w or k pr ocesses ex pose w or k er s t o.
I n t h is p er sp ect iv e, t h e g en er al liv in g an d w or k condit ions or w ay of life appr oach differ s fr om t he t heoret ical m odel of exhaust ion. While t he general liv in g an d w or k con d it ion s or w ay of lif e ap p r oach adopt s t he work process as t he cent ral analysis axis, t h e ex h au st i o n ap p r o ach ad o p t s t h e o ccu p a t i o n a l st r u ct u r e. Th ey ar e sim ilar t o t h e ex t en t t h at bot h adopt social t issue as t he background, t aking dist ance
fr om t r adit ional appr oaches t hat deal w it h t he MHW
pr ocess fr om an Occupat ional Healt h per spect iv e( 19).
St r ess ap p r oach
Th e a p p r o a ch t h a t p r i v i l eg es t h e r el a t i o n
bet w een st r ess and w or k is anot her analy t ic cur r ent dedicat ed t o t he int er r elat ion bet w een m ent al healt h
and w or k . This appr oach, based on st r ess t heor y( 20),
p r e se n t s st r e ss a s d i se q u i l i b r i u m b e t w e e n w o r k dem ands and t he w or ker s’ r esponse capacit y.
I n t he under st anding of t he biopsy chosocial
asp ect s t h at in f lu en ce t h e ( m en t al) h ealt h - d isease
p r o c e s s , t h e s t r e s s a p p r o a c h a d o p t s s o c i a l organizat ion, t he worker’s alienat ion process, t he work
e n v i r o n m e n t a n d s p e c i f i c o c c u p a t i o n s a s t h e
ex planat or y ax es or analy t ic cat egor ies( 21).
Despit e t he im port ance of t he st ress concept t o underst and t he links bet ween t he ( m ent al) healt
h-disease pr ocess and w or k , t her e ex ist s a consensus
t hat it is difficult t o delim it t he ex planat or y ax es or
a n a l y t i c ca t e g o r i e s i n t h e st r e ss a p p r o a ch. Th i s
difficult y has put up t heoret ical- m et hodological barriers
t o t his analyt ic br anch.
The st r ess not ion has been under st ood as a
set of react ions an organism develops when subm it t ed
t o si t u at i o n s t h at ch a l l en g e i t s ad ap t i v e b a l a n ce,
ex p r essin g t h e v icissit u d es an d im p act s of u r b an
-in d u st r ial lif e on su b j ect iv it ies. Th is n ot ion cov er s
at m ospher es pr ev ailing in lar ge cit ies, such as r apid
and v ar ied st im uli, hy per - aler t senses, confr ont at ion
w it h diffuse t hr eat s, feeling of ur gency t o at t end t o
dem ands, am ong ot her s( 1 ).
I n v iew of t he r ange of t his not ion and t he
need t o balance fr ont ier s bet w een differ ent k inds of
know ledge, in clinical pract ice as w ell as in research,
p s y c h o p a t h o l o g y, p s y c h o s o m a t i c s a n d
p s y c h o p h a r m a c o l o g y h a v e a t t e m p t e d t o c l a r i f y
differ en ces bet w een t h e n ot ion s of st r ess, em ot ion ,
em ot iveness, anguish and anx iet y, in t he at t em pt t o
p r eser v e t h e scien t if ic st at u s of t h e t er m . I n t h is
balancing, t he not ion of st ress st art s t o be relat ed t o s i t u a t i o n s o f e x t r e m e p s y c h o s e n s o r y - m o t o r
subj ect ion, bordering on direct dam age t o t he subj ect ’s
int egrit y( 5). I t is a not ion t hat indicat es a st at e result ing
fr om t he or ganism ’s int er act ion w it h har m ful st im uli,
w h ich is t h er ef or e a d y n am ic st at e, in t er ior t o t h e
or g an ism . Th u s, n eit h er t h e st u d en t ’s ex p ect at ion
about an ex am , nor t he pat ient ’s em ot ions about an
ex pect ed sur ger y, or difficult sit uat ions like m or ning
or failure can be considered as st ress. An aggression by st im u li, sy m bols of oppr ession or an y aspect in
t he int er nal or ex t er nal env ir onm ent , w het her social
or not , cannot be consider ed as st ress eit her( 22). I n t h e Men t al Healt h ar ea, t h e alt er at ion s
det er m ined by psy chosocial st r ess ar e char act er ized by a pict ure t hat lies closer t o a syndrom e of sharper
act i v at i o n o r p h y si o l o g i cal v i g o r, m ed i at ed b y t h e
int er pr et at ion for m ulat ed by t he m ent al appar at us in
view of a part icular sit uat ion. The psychosocial fact or
of st r ess em er ges w h en an in t er pr et at ion in dicat es insufficient int er ior r esour ces t o face som et hing t hat
is ex per ienced as a t hr eat( 1).
Sou r ces of st r ess at w or k an d t h eir ef f ect s
o n t h e m e n t a l h e a l t h - i l l n e ss p r o ce ss a r e st u d i e d
t h r o u g h a n a l y t i c c a t e g o r i e s a f f e c t e d b y f a c t o r s
inherent in t he work process, t he individual’s funct ion
in t he organizat ion, work relat ions and t he inst it ut ional
st r uct ur e and at m ospher e( 1).
Th e w o r k p r o c e s s c a t e g o r y i n v o l v e s
w h ich , b esid es ch an g in g t h e sleep cy cle, p r ov ok es
t he feeling of being excluded from com m on sociabilit y
bonds in w or k er s; quant it at iv ely ex cessiv e w or k t hat
is difficult t o assim ilat e, charact erized by m onot onous,
r epet it iv e t ask s w it hout st im uli.
The cat egory funct ion of t he individual in t he
or g an izat ion r ef er s t o t h e f u n ct ion b ias ( w h en t h e
w or k er get s confused by dem ands issued unclear ly ) ,
t h e co n f l i ct b et w een f u n ct i o n s ( r eq u i r em en t s a r e
con t r adict or y an d at t en din g t o on e of t h em im plies
ignoring anot her) , responsibilit y wit h respect t he ot her
p e o p l e ’ s se cu r i t y a n d l i f e , g e n e r a t i n g a d d i t i o n a l
con cer n s( 1 ).
Wor k r elat ion s inv olv e social su p p or t f r om
c o l l e a g u e s , h e a d s a n d s u b o r d i n a t e s , a n d a r e
consider ed an im por t ant v ar iable in w or k er s’ m ent al
healt h. I n t his sense, t he social support t heory point s
t o w a r d s t h e i m p o r t a n ce o f h a v i n g a n e t w o r k o f
relat ions for m ent al healt h m aint enance and recovery
st r at egies( 1 ).
Th e in st it u t ion al st r u ct u r e an d at m osp h er e
cat egor y r efer s t o t he int er nal w or k policy, in t er m s
of t he m echanism t o par t icipat e in decision m ak ing,
r est r ict ion of behav ior s, pr essur e fr om heads, cont r ol
of w or k r hy t hm and t he w or k pr ocess. Most of t hese
fact or s ar e obv iou sly r elat ed t o t h e w ay pr odu ct ion
is or g an ized an d t o h ow social r elat ion s in sid e t h e
l a b o r w o r l d a r e o r i e n t e d t o w a r d s w o r k e r s ’
p ar t icip at ion in or ex clu sion f r om d ecision m ak in g
p r ocesses( 1 ).
The analyt ic branch of st ress has cont ribut ed t o t he under st anding of t he r elat ion bet w een m ent al
in disposit ion an d w or k , per m it t in g t h e iden t if icat ion
of anom alies t hat not necessar ily ar e sy ndr om es or
disor der s, bor der in g on in disposit ion . Th is appr oach
allow s u s t o u n d er st an d t h e n on sp ecif icit y of t h e
suffer ing called m ent al indisposit ion.
D e sp i t e i n n u m e r o u s a t t e m p t s t o p e r f o r m
em pir ical analy ses accor ding t o t he st r ess appr oach, difficult ies involve not only t he concept ual bases and
d e l i m i t a t i o n o f t h e s t u d y o b j e c t , b u t a l s o
m et hodological aspect s. Thus, in spit e of t he st r ess
approach cont ribut ions t o underst and t he healt h- work
p r o c e s s , i t s c o n c e p t u a l l i m i t a t i o n s o r a n a l y t i c
r e d u ct i o n i sm h a s b e e n cr i t i ci ze d( 2 0 ). Cr i t i ci sm i s
direct ed at t he lim it at ions of epidem iological research
a d o p t e d i n w o r k e r s’ m e n t a l h e a l t h a sse ssm e n t ,
allow in g com p an ies t o elim in at e su b j ect s su f f er in g
f r o m e v e n l i g h t m e n t a l sy m p t o m s o r b e h a v i o r a l
disorder s( 3, 5- 6).
I n f a ct , t h e st r e ss a p p r o a ch a d v a n ce s i n st udies on workers’ m ent al phenom ena by using social
epidem iology in it s invest igat ions, specifying t he social
aspect s and analy zing st r ess as a m ediat or bet w een
t he social and t he biological. However, in using som at ic
and biological crit eria in t he assessm ent , t his approach
does not address t he elem ent s inherent in t he m eaning
p r o ce ss, n o r t h e w o r k e r s’ su b j e ct i v e e x p e r i e n ce ,
get t ing dist ant fr om a t heor et ical for m ulat ion of t he
social pr ocess.
Er g on om ic ap p r oach
Er g o n o m i c s i s a n i n t e r d i s c i p l i n a r y f i e l d , i n v o l v i n g e n g i n e e r i n g , m e d i c i n e , p s y c h o l o g y,
sociology, psy chophy siology and econom ics. I nit ially,
it is con sid er ed as t h e r elat ion b et w een m an an d
m achine. This under st anding w as ex panded t hr ough
a change of focus in st udies about w or k , w her e t he
h u m a n f a ct o r st a r t s t o b e f a ced a s a n i m p o r t a n t
elem ent in t he m an v er sus m achine binom ial.
The analy t ic br anch of er gonom ics is based on t he adopt ion of psychosocial fact ors as t he analyt ic
axis in t he healt h- disease process( 22- 23). The physical,
cognit ive and m ent al fact or s st and out , in w hich one
aspect int eract s and det erm ines anot her. Each of t hese
fact or s can det er m ine an ov er load or suffer ing. They
are int errelat ed and, as a rule, an overload in one of
t hese aspect s is accom panied by an increased burden
in t he ot her t wo areas( 22).
The er gonom ic appr oach is m ar k ed by t hr ee
d i st i n ct m o m e n t s: 1 - co n ce r n s m a i n l y f o cu s o n
p h y si o l o g i c m o d i f i ca t i o n s e x e r ci se d b y t h e w o r k
pr ocess, pr iv ileging phy sical fat igue; 2- t he focus is
dir ect ed at t he inv est igat ion of psy cho- phy siological
aspect s; 3- st udies look at psy chosocial fact or s and
t heir r eper cussions for chr onic m ent al fat igue( 24).
I n t h e an aly sis w or k an d it s r ep er cu ssion s
for individuals’ healt h, it is highlight ed t hat work wit h
cog n it iv e b u r d en s, w h ose con t en t s im p ly in cr eased
m ent al effor t , can lead t o t he em er gence of neur ot ic
sy n d r o m e s. On e e x a m p l e i s h e a l t h w o r k , w h i ch
r equir es r apid t hink ing and decision m ak ing, difficult
relat ions w it h client s, very close or rest rict ive cont rol
by heads( 22).
Er g o n o m i cs st u d i e s h a v e b e e n cr i t i ci ze d , esp eci al l y r el at ed t o t h e u n d er st an d i n g o f m en t al
healt h on t he basis of t he physiologic effect s of work.
Cr it icism indicat es t hat t he or iginal st r ess concept is
asp ect s o f m en t al h eal t h at w o r k an d t h e so ci al
-p o l i t i c a l - e c o n o m i c c o n t e x t i t i s i n s e r t e d i n( 2 5 ).
Li m i t at i o n s o f t h i s ap p r o ach r ef er t o t h e m u l t i p l e
nat ures of w ork t ension sources - physical, chem ical,
b iolog ical, social, econ om ic, cu lt u r al an d p olit ical
-g e n e r a l l y e x e r c i s i n -g t h e i r e f f e c t s t h r o u -g h
sim ult aneous act ions or, quit e frequent ly, int eract ions,
rendering difficult t he specific effect s of one or anot her
t ension- pr oducing agent in r eal condit ions( 24).
Despit e differ ent cr it icism s against t he lim it s
o f t h e e r g o n o m i c a p p r o a ch , w h e t h e r d u e t o t h e
t heor et ical fr am ew or k , t he delim it at ion of t he st udy
obj ect or t he adopt ed m et hodological st r at egies, it s
cont r ibut ions t o t he st udy of w or k er s’ m ent al healt h
a r e u n d e n i a b l e , e s p e ci a l l y i n d e f i n i n g h o w i t i s
influenced by w or k condit ions.
Wor k psy ch opat h ology appr oach
The analyt ic branch of work psychopat hology
c o v e r s t h e a n a l y s i s o f t h e d y n a m i c s o f m e n t a l
p r ocesses m ob ilized b y t h e su b j ect ’s con f r on t at ion
wit h t he work realit y, base don st udies( 2- 7) t hat adopt
t he organizat ion of w ork and m ent al suffering as t he
cen t r al an aly t ic cat egor ies, em ph asizin g t h e r ole of
t h e d e f e n s e s w o r k e r s a d o p t a s m e c h a n i s m s t o
m aint ain m ent al equilibr ium .
I n select ing m ent al suffering as t he cat egory, t h i s a p p r o a c h t a k e s d i s t a n c e f r o m t h e o r e t i c a l
concept ions t hat addr ess t he r elat ion bet w een w or k
and ( m ent al) healt h/ disease fr om t he per spect iv e of
c l a s s i c a l p s y c h i a t r i c n o s o l o g y, c o n s t r u c t i n g
psychopat hological profiles. I t also t akes dist ance from
concept ions t hat adopt t he fram ework of occupat ional
m e d i c i n e a n d r e l a t e r i s k s w i t h s p e c i f i c m e n t a l
d iseases.
I n D e j o u r i a n s t u d i e s( 2 - 8 ), t h e w o r k e r ’ s
su f f er in g is ex pr essed by f eelin gs of dissat isf act ion
and anxiet y, deriving from t he work cont ent s’ lack of
m e a n i n g f o r t h e su b j e ct , f a t i g u e , a s w e l l a s t h e
e r g o n o m i c co n t e n t s a n d b u r d e n s o f w o r k . Th e se
s t u d i e s d i s t i n g u i s h b e t w e e n t h e d i s s a t i s f a c t i o n
produced by t he ergonom ic cont ent s ( suffering relat ed
t o t h e con t en t s’ lack of ad eq u acy t o t h e w or k er ’s
apt it udes and needs) and t he suffering caused by t he
“ significant cont ent s” or “ sym bolic cont ent s of w or k ”.
Dissat isfact ion r elat ed t o t h e sign ifican t con t en t s of
t he j ob pr oduces suffer ing w it h a m ent al im pact , as
o p p o s e d t o t h e s u f f e r i n g t h a t r e s u l t s f r o m t h e
ergonom ic cont ent s. However, it should be highlight ed
t hat m ent al suffering result ing from frust rat ion at t he
level of t he significant cont ent s of t he j ob can equally
lead t o som at ic diseases( 3).
The difference bet ween t he t heoret ical m odel
of Wor k Psy ch op at h olog y an d t h e p r ev iou s m od els
( w ay of lif e, ex h au st ion , st r ess an d er gon om ics) is
t hat t he form er adopt s m et hodological st rat egies t hat
privilege t he report of workers’ subj ect ive experiences
and t heir feelings of anx iet y, fear, dissat isfact ion, in
sh o r t , t h ei r su f f er i n g ab o u t w o r k , as m at er i al f o r
an aly sis.
The ergonom ic m odel privileges t he obj ect ive
aspect s of t he w or k condit ion, using analy t ic m odels
t h at at t em pt t o iden t ify obser v able elem en t s in t h e
en v ir on m en t .
Th e p sy ch osocial st r ess m od el also d if f er s
fr om t he Wor k Psychopat hology m odel t o t he ex t ent
t h at it pr iv ileges qu an t if icat ion , w it h ou t con sider in g
t h e s u f f e r i n g s u b j e c t ’ s e x p e r i e n c e . S t r e s s
m easurem ent ignores t he experiences of t he st ressed
subj ect and v alues neit her t he suffer ing nor w ay s of
m ent ally m et abolizing it . The privilege of quant ificat ion
f av or s t h e id en t if icat ion of d ev iat ion s, ex cesses or
d ef icit s in cer t ain p ar am et er s, b u t d ed icat es lit t le
at t ent ion t o t he qualit at iv e subj ect iv e ex per ience.
Wor k Psy ch opat h ology adopt s con cept s lik e
w o r k l o a d , f r e e b e h a v i o r, st e r e o t y p e d b e h a v i o r,
significant and ergonom ic cont ent s of work in relat ion
t o per son alit y st r u ct u r e, m en t al su f f er in g, f low an d
dest inat ion of v ibr at ions, st r uct ur ing of t he oper at iv e
m ode, psy ch osom at ic econ om y, def en se st r at egies,
am on g ot h er s.
B y m e a n s o f t h e s e c o n c e p t s , Wo r k
Psy ch o p at h o l o g y i d en t i f i es t h e p sy ch o p at h o l o g i cal
effect s of t h e scien t ific or gan izat ion of w or k on t h e
w or k er ’s m en t al appar at u s, in fu n ct ion of t h e t r iple
div ision : div ision of t h e oper at iv e m ode, div ision of
t h e o r g a n i sm b e t w e e n e x e cu t i o n a n d i n t e l l e ct u a l
concept ion organs and division bet ween m en. Workers’
m ent al apparat us does not adhere t o t he organizat ion
o f r e p e t i t i v e a n d m e a n i n g l e ss w o r k . Th u s, t h e se
i n d i v i d u a l s ’ e x p e r i e n c e s g i v e r i s e t o a “ m e n t a l
su f f e r i n g ” t h a t i s u n a v o i d a b l y g e n e r a l i ze d t o l i f e
out side w or k( 3).
I n psychiat ry, workers’ m ent al healt h aspect s
ar e con cen t r at ed in m en t al ch an ges w h en t h ey ar e
a l r ea d y ev i d en ced , a ck n o w l ed g ed a n d l a b el ed b y
d iag n ost ic act ion s. To ov er com e t h is r ealit y, Wor k
Psy chopat hology seek s t o adv ance on t he pr eclinical
of alt er at ions int o t he r esear ch ar ea w hich, alt hough
n ot ch ar act er ized as t y p ical d iseases, ar e alr ead y
unm ist akable signs of m ent al suffering, or even act ive
f o r m s o f s t r u g g l i n g a g a i n s t t h e d i s e a s e t h a t i s
t hr eat ening t o inst all.
Tw o basic concept s illust rat e t his advance in
Work Psychopat hology. These are: “ Healt h and m ent al
illness are not st agnant poles, but a dynam ic process,
per m eat ed by in t er m ediar y n u an ces an d su bj ect t o
dest abilizat ion an d r ebalan cin g”( 1 ) an d “ Th e m in d is
n ot in dif f er en t t o t h e liv e w or k scen e, as cou ld be
suggest ed by t he silence about t he subj ect . On t he
cont rary, it const it ut es it s first point of incidence. When
insert ed int o a work process, t he individual est ablishes
a con st an t in t er act ion bet w een h is psy ch obiological
program ( considered as a set of biological and m ent al
variables and apt it udes, expect at ions, needs et c.) and
t h e w o r k l o a d s o r i g i n a t i n g f r o m t h e i m m e d i a t e
t e ch n o l o g i ca l m a t e r i a l i t y a n d t h e f o r m s o f w o r k
or g an izat ion an d m an ag em en t , w it h t h eir d if f er en t
degr ees of phy sical and m ent al im pact ”( 1)
Un t i l r e ce n t l y, m e n t a l su f f e r i n g w a s o n l y
consider ed in r elat ion t o t he w or k er ’s m ent al healt h
w hen it w as t um ult uous, ex plicit and ex cessiv e. Any
ot h er su f f er i n g t h at escap ed f r om t h i s f r am ew or k
seem ed w it h ou t ev id en ce, b elow t h e r each of t h e
clinical look and t he list ening needed t o decipher it .
Not acknowledged as a disease in t he light of already
cod ed k n ow led g e, t h is su f f er in g escap ed f r om an y
t h eor et ical or clin ical t h em at izat ion , as if it lack ed
l e g i t i m a c y t o b e c o m e a n o b j e c t o f c o n c e r n o r
r esear ch( 1 ).
Wo r k Psy ch o p a t h o l o g y i s o p p o sed t o t h i s
m ovem ent of neut ralizing indisposit ion and neut ralizing
su f f er in g . I t t ak es in t er est ex act ly in t h e w or k er s’
discourse, in t heir experiences, in what is not explicit
in behav ior, in w hat was silenced by t he disguise of
pr oduct iv e and st er eot y ped conduct .
Thus, fr om a m et hodological v iew point , t his
analyt ic branch privileges qualit at ive over quant it at ive
aspect s, accor din g t o it s epist em ological n at u r e. I t
looks at t he subj ect ive experience of suffering, whose
ex p r ession n ecessar ily in v olv es sy m b olic m ed iat ion
and int er subj ect iv e r elat ions. Wor k Psy chopat hology
ex am in es in div idu als’ pleasu r e/ su ffer in g equ at ion in
t heir daily and repeat ed relat ions wit h work. I t seeks
t h e ef f ect s o f t h i s eq u a t i o n a n d w o r k er s’ m en t a l
dy n am ics. I n sh or t , it em ph asizes t h e cen t r alit y of
w o r k i n su b j ect s’ l i v es, a n a l y zi n g a sp ect s o f t h i s
act ivit y t hat can favor healt h or illness.
Th e p o i n t o f i n t e r s e c t i o n b e t w e e n Wo r k
Psy ch o p at h o l o g y an d p sy ch o an al y si s i s t h e act o f
pr iv ileging indiv iduals’ st at em ent s about t heir w or k ,
list en in g t o t h eir discou r se abou t t h eir ex per ien ces
and t heir silences r elat ed t o cer t ain point s or issues
t hat ar e consider ed cr ucial for w or k per for m ance. I f
t he indiv idual r em ains silent about a cer t ain subj ect ,
or refuses t o t alk about it , or does not even m ent ion
a n y t h i n g a b o u t t h i s s u b j e c t , a c c o r d i n g t o
psy choanaly t ic per cept ion, t his const it ut es a defense
dev ice t o fight against t he per cept ion of suffer ing.
At t h is poin t , an ot h er f u n dam en t al con cept
of Wor k Psychopat hology appear s: defense st rat egies
a n d p a r t i c u l a r l y s u b l i m a t i o n . Th e s e s t r a t e g i e s
cont r ibut e t o j oin w or ker s, unit e t he w or k gr oup and
m i n i m i ze m en t a l su f f er i n g . Th ey a l so b en ef i t t h e
for m at ion of a v alue sy st em t hat st ar t s t o const r uct
t he so- called “ defensive ideology of t he profession” ( 6).
These collect ive st rat egies are form ulat ed on t he basis
of w or k er s’ gr oup ex per ience, seek ing t o m aint ain a
m ent al balance, ev en if pr ecar iously, in v iew of t he
t hr eat s pr esent in t he w or k env ir onm ent .
Th e Wo r k Ps y c h o p a t h o l o g y a p p r o a c h
considers work, part icularly work organizat ion, in t wo
dim en sion s: on e pat h ogen ic an d an ot h er pr ot ect in g
m ent al healt h.
Th e m e n t a l h e a l t h - p r o t e c t i n g d i m e n s i o n
depen ds on t h e ex ist en ce, bet w een t h e w or k er an d
t h e pr escr ibed w or k , of som e r oom for n egot iat ion ,
som e possibilit y t o adj ust t he oper at iv e m ode t o t he
p r of ile of t h e ex ecu t or. Wh en w or k or g an izat ion is
r i g i d l y s t r u c t u r e d , i g n o r i n g t h e i m p o r t a n c e o f
so ci o t e ch n i ca l sy st e m s, a n d a t t r i b u t i n g a b so l u t e
p r im acy t o t h e econ om ic asp ect , t h is w ill r esu lt in
disagr eem ent , in incom pat ibilit y bet w een t he w or k er
and t he operat iv e m ode. For Wor k Psy chopat hology,
t his pr ocess alw ay s w or k s im pov er ishing, because it
r est r ict s, disfigu r es, st iffen s t h e en t ir e v er sat ilit y of
t he m ent al apparat us, producing suffering and creat ing
possibilit ies f or decom pen sat ion of w or k er s’ m en t al
h e a l t h , w h i c h , d e p e n d i n g o n t h e p r e f e r r e d
p sy ch o l o g i ca l m e ch a n i sm s, w i l l a cq u i r e n e u r o t i c,
char act er or psy chosom at ic t r ait s( 2).
Th e Dej ou r ian appr oach ev iden ces t h e r ole
of work organizat ion in workers’ m ent al healt h, which
sh o u l d b e an el em en t o f co n cer n f o r ex p er t s an d
pr ofessionals in r esear ch as w ell as ser v ices.
Healt h st u dies h av e fr equ en t ly adopt ed t h e
Wor k Psy ch opat h ology appr oach . Th ese an aly ze t h e
su b j ect ’s con f r on t at ion w it h t h e w or k r ealit y. Th ey
address work as a dynam ic locus, in which ident it y is
const ruct ed and cont inuously t ransform ed, evidencing
d if f er en t iat ed w or k r elat ion s ( as an ef f ect of w or k
organizat ion) t hat int erfere in workers’ m ent al healt h.
FI NAL COMMENTS
Th e h e a l t h a r e a st u d i e s t h e i n t e r r e l a t i o n
bet ween m ent al healt h and work t hrough t he analyt ic b r a n ch e s o f e x h a u st i o n , g e n e r a l l i v i n g a n d w o r k
c o n d i t i o n s , s t r e s s , e r g o n o m i c s a n d w o r k
p sy ch op at h olog y. Th ese t h eor et ical m od els p r esen t
i m p o r t a n t c o n t r i b u t i o n s t o t h e p r o c e s s u a l
underst anding of t his int errelat ion, covering psychiat ric
i n d i s p o s i t i o n , w h i c h i n c l u d e s m e n t a l s u f f e r i n g ,
conceiv ed as an int er m ediar y space bet w een m ent al co m f o r t o r w el l - b ei n g an d d eco m p en sat ed m en t al
illn ess.
Th e se co n t r i b u t i o n s o f f e r p o ssi b i l i t i e s f o r
research and int ervent ion in t he work place, especially
in t erm s of work organizat ion and it s st ruct uring role,
t hat is, it s role in m ent al healt h prom ot ion, which can suppor t t he adopt ion of pr ev ent ion st r at egies aim ed
at w or k er s’ m ent al healt h.
Theoret ical branches support ing st udies about
t h e in t er r elat ion b et w een m en t al h ealt h an d w or k
assu m e d if f er en t con cep t ion s in t h e sp h er e of t h is
b i n o m i a l , o f f e r i n g t h e p o s s i b i l i t y o f a m o r e cont ex t ualized r esear ch t o specialist s.
Th ese m od els, h ow ev er, f ace a con sen su al
d i f f i cu l t y w i t h r esp ect t o t h e a d o p t ed t h eo r et i ca l
con cep t ion s, af f ect in g b ot h t h e d elim it at ion of t h e
o b j ect , t h e ch o i ce o f a n a l y t i c ca t eg o r i es a n d t h e
a d o p t e d m e t h o d o l o g i c a l s t r a t e g i e s . Th i s e n t a i l s
im p licat ion s f or r esear ch er s’ in t ellect u al p r od u ct ion in t his area. When adopt ing one or anot her t heoret ical
m odel, t hey are confront ed wit h concept ual difficult ies,
deriving from t he unspecific charact er of t he involved
cat egor ies, w h ich m ay lead t o u n av oidable h ar m f u l
r eper cussions for t he m et hodological aspect of t hese
st u dies.
Th is con sen su al dif f icu lt y t o appr eh en d t h e lin k b et w een m en t al illn ess an d t h e w or k sit u at ion
const it ut es a process t hat is specific for each individual,
inv olv in g h is/ h er lif e an d w or k h ist or y. Th is im plies
t h e id en t if icat ion of t h e w or k sit u at ion in t er m s of
en v ir on m en t , or gan izat ion an d per cept ion of w or k ’s
influence in t he m ent al illness pr ocess. This difficult y
is also present in t he associat ion bet ween clinical and
w or k sit uat ion, w hich com plicat es t he est ablishm ent
o f a t a x o n o m y o f w o r k- r el a t ed m en t a l d i so r d er s.
Despit e agr eem en t abou t t h e et iological im por t an ce
of w or k , t her e is no consensus about t he w ay w or k and m ind are connect ed. This could offer a t heoret ical
fr am ew or k t o analy ze t his connect ion.
I n view of t hese difficult ies, t here is an urgent
need for st udies t hat look at w ork load and cont ent s
t h r ou g h ar t icu lat ion s b et w een t h ese elem en t s an d
w or k er s’ p er son alit y st r u ct u r e, as t h e m en t al w or k l o a d i s u n d o u b t e d l y v e r y c o m p l e x a n d i n v o l v e s
n e u r o p h y s i o l o g i c , c o g n i t i v e a n d p s y c h o l o g i c a l
p h en om en a.
Anot her im port ant aspect is t he developm ent
o f i n t e r d i s c i p l i n a r y s t u d i e s t h a t p e r m i t a n
under st anding of t he psy chosocial dim ension of w or k
an d it s r elat ion w it h m en t al h ealt h , as t h is pr ocess inv olv es psy chological, sociological and phy siological
aspect s. Thus, analyses in a m ult idisciplinary field m ust
at t em pt t o underst and t he relat ions bet ween t he work
pr ocess an d m en t al h ealt h , u sin g an appr oach t h at
se e k s t o a p p r e h e n d t h e p sy ch o a f f e ct i v e , so ci o
-cult ural, econom ic and polit ical det erm inant s inherent in t he w or k pr ocess, as w ell as it s r eper cussions for
w or k er s’ m ent al healt h.
Wit h r espect t o t h eor et ical appr oach es t h at
support t he analysis of workers’ m ent al healt h, a new
st udy agenda has t o be or ganized, w hich int egr at es
different perspect ives on t he obj ect ( t he work process, occupat ional insert ion, t he work environm ent and t he
m en t al h ealt h - disease p r ocess) an d allow s f or n ew
m et h odological alt er n at iv es at t h e lev el of r esear ch
and or ganizat ional int er v ent ion.
Fi n a l l y, w e r e c o m m e n d t h a t m u l t i p l e
appr oach es be adopt ed, pr ov ided t h at t h ey ar e n ot
cont radict or y, in fut ur e MHW st udies. These st udies, in t urn, should t ake int o account t hat work is a part of
t he const ruct ion of individual ident it ies and, t herefore,
not only a m er e w ay of m ak ing a liv ing, but also a
cr eat iv e p r ocess. Th u s, w or k an d it s con seq u en ces
for individuals’ m ent al healt h should also m ake sense
t o t he w or k er s, t hat is, giv e pleasur e and a cer t ain
degr ee of sat isfact ion.
Fo r M H W r e s e a r c h e r s , o v e r c o m i n g t h e
bar r ier s appoin t ed f or each appr oach in t h is ar t icle
indicat es t hat , in or der t o cope w it h such a com plex
t h em e, t h er e is a n eed t o m ov e bey on d t h e u se of
appr oaches t hat em phasize only one of t he m ult iple
REFERENCES
1. Souza AL de. Saúde m ent al e t rabalho: dois enfoques. Rev Br as Saúde Ocupacional 1992 j aneir o- j unho; 20( 75) : 65- 71. 2 Dej ours C. Por um novo conceit o de saúde. Rev Bras Saúde Ocu p acion al 1 9 8 6 j an eir o- j u n h o; 5 4 ( 1 4 ) : 7 - 1 1 .
3. Dej ours C. A loucura do t rabalho: est udo da psicopat ologia do t r abalho. 5ª ed. São Paulo ( SP) : Cor t ez/ Obor é; 1987. 4 . D ej o u r s C. Tr a n st o r n o s m en t a l es r el a ci o n a d o s co n el t r abaj o. I n: Kalim o R, El- Bat aw i M, Cooper C. Los fact or es psicosociales em el t rabaj o y su relación con la salud. Ginebra: Or ganización Mundial de la Salud; 1988.
5. Dej ours C. O corpo ent re a Biologia e a Psicanálise. Port o Alegr e ( RS) : Ar t es Médicas; 1 9 8 8 .
6 . Dej ou r s C. I n t r odu ção à psicopat ologia do t r abalh o. I n : Hir at a H, or ganizador. Divisão capit alist a do t r abalho. Tem po Social - ev Sociol USP 1 9 8 9 j an eir o- j u n h o; 1 ( 2 ) : 7 3 - 1 0 3 . 7 . Dej ou r s C. Um a n ov a v isão do sof r im en t o h u m an o n as or g an izações. I n : Ch an lat JF, or g an izad or. O in d iv íd u o n a or ganização: dim ensões esquecidas. 2ª ed. São Paulo ( SP) : At l a s; 1 9 9 3 .
8 . Lu n a r d i Fi l h o W D . Pr a ze r e so f r i m e n t o n o t r a b a l h o : co n t r i b u i çõ es á o r g a n i za çã o d o p r o cesso d e t r a b a l h o d a enfer m agem . Rev Br as Enfer m agem 1 9 9 7 ; 5 0 ( 1 ) : 7 7 - 9 2 . 9. Borsoi I CF, Codo W. Enferm agem , Trabalho e Cuidado. I n: Codo W, Sam pio JJC, organizadores. Sofrim ent o psíquico nas organizações: saúde m ent al e t rabalho. Pet rópolis ( RJ) : Vozes; 1 9 9 5 . p . 1 3 9 - 5 1 .
10. Fer nandes JD, Fer r eir a SL, Alber gar ia C, Conceição FM, Fer nandes J. Saúde Ment al e Trabalho Fem inino: im agens e r epr esent ações de enfer m eir as. Rev Lat ino- am Enfer m agem 2 0 0 2 m ar ço - ab r i l ; 1 0 ( 2 ) : 1 9 9 - 2 0 6 .
1 1 . Lau r ell AC. Pr ocesso d e t r ab alh o e saú d e. Saú d e em Deb at e CEBES 1 9 8 1 ; ( 1 1 ) : 8 - 2 2 .
1 2 . Lau r ell AC. A saú de- doen ça com o pr ocesso social. I n : Du ar t e E, or gan izador. Medicin a Social: aspect os h ist ór icos e sociais. São Paulo ( SP) : Global; 1983. p. 25- 64.
1 3 . Lau r ell AC, Nor iega M. Pr ocesso de pr odu ção e saú de: t rabalho e desgast e operário. São Paulo ( SP) : Hucit ec; 1989. 1 4 . S e l i g m a n n - S i l v a E. D e s g a s t e M e n t a l n o Tr a b a l h o Dom inado. Rio de Janeir o ( RJ) : UFRJ/ Edit or a Cor t ez; 1994. 1 5 . Selig m an n - Silv a E. Psicop at olog ia e p sicod in âm ica n o t rabalho. Rio de Janeiro ( RJ) : Ed. At heneu; 1995.
16. Rut enfranz JK, Fisher FM. Trabalho em t urnos e not urno. São Pau lo ( SP) : Hu cit ec; 1 9 8 9 .
1 7 . Vog e C. Pr ob lèm es m éd icau x et m éd ico- lég au x p osés p ar les ag r ession s à m ain ar m ée d an s les ét ab lissem en t s bancaires. I n: Dej ours C, Veil C, Wisner A. Psychopat hologie du Travail. Paris: Ent erprise Moderne d’Edit ions/ Edit ions ESF; 1 9 8 5 . p . 8 7 - 9 4 .
1 8 . Possas C. Epidem iologia e sociedade: h et er ogen eidade est rut ural e saúde no Brasil. São Paulo ( SP) : HUCI TEC; 1989. 19. Fernandes SRP. Saúde e t rabalho: cont rovérsias t eóricas. Cad er n o CRH 1 9 9 6 j an eir o- d ezem b r o; 2 4 ( 2 5 ) : 1 5 5 - 6 9 .
20. Karasek RA, Theor ell T. Healt hy Wor k . New Yor k ( USA) : Basi c Bo o k s; 1 9 9 0
2 1 . Gar dell B. Scan din av ian r esear ch on st r ess in w or k in g life. I nt Healt h Ser v ices 1 9 8 2 Januar y - Mar ch; 1 2 ( 1 ) : 3 6 - 4 5 . 22. Wisner A. Por dent ro do t rabalho - ergonom ia: m ét odo e t écn ica. São Pau lo ( SP) : FTD/ OBORE; 1 9 8 7 .
2 3 . Fi s h e r EM , Pa r a g u a y A I B B . A e r g o n o m i a c o m o inst rum ent o de vida e de t rabalho. I n: Fisher EM, Gom es C, or gan izador es. Tópicos de saú de do t r abalh ador. São Pau lo ( SP) : HUCI TEC; 1 9 8 9 .
24. Seligm ann- Silva E. Saúde m ent al e t rabalho. I n: Tundis SA, Cost a NR Cidadania e loucura: polít icas de saúde m ent al no Br asil. Rio de Janeir o ( RJ) : Vozes/ Abr asco; 1987. 2 5 . Seligm ann E, Sat o L, Delia A. Condições de t r abalho e saúde em funcionár ios da OPM do m et r ô de São Paulo. São Pau lo ( SP) : DI ESAT; 1 9 8 6 .
