Moral harassment, ethics and psychological stress in workplace

Moral harassment, ethics and psychological stress in workplace The moral harassment is a complex phenomenon and a current reality in the working world. To qualify an action as moral harassment, the harasser’s intention, the endurance and frequency must be investigated. It is a violence that involves individual and collective ethical principles that may affect the workers’ life quality, leading to physical and psychosomatic illnesses, and work related suffering. This narrative text defines and characterizes moral harassment in its relation to ethics, the main results on workers health, and briefly comments about international and national legislation on this theme.


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Throughout history, the work process has gone through different approaches. From the relations under the slavery and servitude regimes to those under the aegis of paid work, the work process went through different protection levels to the health of workers. The Industrial Revolution introduced a concern with protecting the physical integrity of the labor force. With the 1st World War, the concern about the quality of life at work has started and, in the late 1960s, the mental health worker was covered up in the focus of occupational health 1 .
This process shows the adaptation of human beings to changes in the world in all aspects, and especially in the work -which is a considerable part of human life. This meaning connotes the work as a process which extends beyond survival, which currently means considering work and health at work as citizenship rights.
Whatever compulsory or effect of the characteristics of the activity performed, the daily work is imbued with many stressing factors. Besides these inherent difficulties, the work activities are subject to another factor which maximizes stress: the moral harassment. Also known as moral violence at work, this ancient practice has only been visualized recently, as the emergence of notions of human rights and citizenship allowed realizing its recurrence in the workplace, especially in activities where there is a predominance of women, such as nursing case.
Moral harassment is characterized by subjecting the employee to constant humiliation and embarrassment. It is expressed, however, in violent and unethical attitudes, causing negative repercussions on the identity of the person harassed, abusing his sense of dignity and violating their fundamental rights 2 . Thus, it is important that workers are trained to recognize, avoid and fight bullying.
Thus, this narrative reflection defines and characterizes moral harassment, by relating to ethics for the better understanding of harassment in the workplace; it reports the main repercussions on the health of workers and comments briefly on the international and national legislation on this subject, in order to assist professionals in the health field to realize the phenomenon in the workplace and thus keep their suffering with lower physical and mental health in professional and personal life.

Definition and relation: moral harassment and ethics
In order to understand the relationship of ethics and moral harassment, it is essential to understand the origin of the word ethics comes from the Greek ethos, meaning way of being. Thus, it can be defined as a set of values which guide human behavior in relation to other men in the society in which they live, thus providing the social welfare. Therefore, ethics determines how the human being should behave in the social environment in which he lives 3 .
In turn, the understanding of moral harassment stems from scientific studies in the field of Psychology and Medicine, which analyzed occurrences in the workplace and its effects on the health of individuals 2 . According to the World Health Organization (WHO), the phenomenon involves, literally, the constitution of "multi-attitudes" around someone to attack him 4 . The conceptualization and theorizing about workplace moral harassment are recent, but the history, mythology and religions refer this behavior to Antiquity 5 .
The term moral harassment can be replaced by mobbing, due to the effects caused in the mental health of workers 2,4 . This term was identified in 1984 by German psychologist Heinz Leymann, and defined as repeated and reprehensible or clearly negative actions, which are offensively addressed against employees, which may lead to their isolation from the group in the workplace 6 . Although it has been identified primarily by Psychology, other areas, such as Philosophy, search for explanations on moral harassment with focus on the ethical view on the subject 1 .
Moral harassment is characterized by the deliberate degradation of working conditions, since when there is an effect; it is able to establish a pact of tolerance and collective silence about the gradual weakening and destabilization of the victim. This one gradually loses his self-esteem, doubts about himself and feels as liar, to the extent of he feels discredited by the others. Thus, his defenses are annihilated and his confidence is gradually shattered, making their work activities and sometimes the familiar and social ones difficult or even impossible 6,7 .

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It is considered vertical harassment the one which stems from abusive behavior of superiors to constrain subordinates, and horizontal harassment happens when workers aim, among themselves, to exclude one or another colleague who are not desirable to the group 7 . There is also combined mobbing -when the superior and the colleagues want to exclude an individual -and the ascendant mobbing -one or several workers think they deserve the position of their superior and they start to boycott him 8,9 .
Such behavior can be related to several factors, among which stand out discrimination and envy 8 . It is also known that moral harassment has been linked to factors of gender, race, sex, religion, age, nationality, work ability, records and socioeconomic status, and is constituted into a practice related to the culture which happens all over the world. However, the way of noticing varies from country to country 8 .
The International Labor Organization (ILO), in conjunction with WHO, demonstrated in a survey, in 2000, that the perspectives for the next 20 years, for workers, are very pessimistic regarding the psychological aspects; stating that stress, anguishes, family maladjustments, the suffering at work arising from different causes and other psychological damage, including the one coming from moral harassment, tend to predominate in the work environment in the next decades 8 . Although the phenomenon of moral harassment, by itself, is not a disease, the effects of this practice are able to cause diseases. A classic example of such repercussions refers to anxiety which the harassed one may have, caused by the suffering to which he is being subjected and that can cause physical and psychological harm 10 .
In health area, the phenomenon happens in the same way than in other professions. All professionals, including physicians, category with vast majority consisting of men, can be victims of disturbances arising from adverse working conditions. In relation specifically to these professionals, especially those ones who work in public institutions, the working conditions can influence the perception and characterization of moral harassment can be easily confused with overwork 11 .
In fact, some studies 10,12 emphasize that moral harassment can be confused with stress, especially in those situations where the lack of personnel in the institution involves individual work overload. In these cases, the professional may connote harassment to stress and its effects can be attributed to excessive professional activity. Therefore, there is need to better understand the phenomenon and its repercussions in order to prevent such violence at work 7,8 . Some authors also point out that the full recognition of the harassment charge is essential to pressure the political institutions on the treatment of the worker harassed, since harassment can cause physical and mental disorders, as well as compromising family and social ties.
Another aspect to be noted is that many companies have a code of ethics to try to prevent acts of bullying, but only this is not enough. It should be created mechanisms that could avoid such violence and implement a process of humanization in job, by creating spaces for discussion, dialogue, effective communication and coping so that they can openly discuss on individual and collective problems of workers 13 .
Such internal policies are crucial in order not to forget about harassment cases, leading to a huge human and social cost for institutions, and not only discussed in legal field, which generates sporadic indemnifications in cases that the practice is legally proven. So, it is inferred that psychic suffering of the workers in the vast majority of times is left on the sidelines, since it is about subjective aspects.

Characterization of moral harassment
For the ILO, thousands of workers suffer from bullying. A study carried out in the European Union shows that 8% of the workforce, or approximately twelve million individuals receive from their bosses a tyrannical treatment. In this sense, despite harassment have already been defined for over 25 years, which is observed empirically is that the workers' psychological distress is still trivialized.
In Brazil, research conducted in 97 firms in the State of São Paulo, with 2,072 respondents, showed that 42% made explicit stories of humiliation at work and that, from this number, women are the most frequent victims. Other victims commonly affected by harassment are blacks, homosexuals, people with special needs, workers above 40 years old and people with repetitive strain lesion 6,7 . From this situation, it is possible to deduce that workers with such characteristics need to be alert to the possibility of being victims of bullying when their working relationships are characterized by frequent abusive and aggressive episodes.
The diagnosis of such social conditions is difficult and it is characterized by small regular attitudes towards the target. These attitudes do not happen brutally, instantly and noticeably, as seen, Moral harassment, ethics and psychological stress in workplace Update Articles for example, in the physical torture. Thus, hostile and punctual practices are not necessarily characterized as moral harassment and they often may arise from specific situations of tension which affect one of the interlocutors, both or even the work dynamics. Nevertheless, situations involving some hostility should be the object of reflection and analysis, since they may seem unimportant, but they may hide a disaster 14 .
Actions and attitudes in the workplace can be qualified as moral harassment when some criteria are observed: 1) abusive or aggressive act, 2) repetition, frequency, duration of these hostile practices, 3) the intention of the stalker. It is necessary to consider the influence of cultural and the objectives of the stalker 10 .
Repetition can be referred to the same act or omission or, then, to different acts and omissions.
What is important to understand if there is a hostile attitude, constant, expressed or implied abuse or aggression. The repetition of these actions destabilizes the victim, leading him to develop diseases, and compromising their identity, dignity and social and emotional relationships. It is important to reaffirm that the difficulty of noticing harassment makes it an invisible risk, but concrete in relations and working conditions 7,15 .
However, the repetition should not be considered in an isolated way, because there may be a repetition of acts without the frequency or the duration, which are also key aspects in the characterization of harassment. Zanetti informs that a single act, even if it is repeated often enough, cannot be considered as bullying, but as psychological violence, by citing as an example the slander 14 . To characterize the frequency, inherent in moral harassment, repetition must occur at least once a week, otherwise the episode will not be considered as bullying, according to their current characteristics under the international context 16 .
With regard to duration, time may vary from a week to one to three years 16 . Several studies 7,10,14 showed that the average length of the attacks on the part of the harasser is six months. The length is a very important aspect regarding prevention, because the study of many cases has demonstrated that none of them would have become harassment if intervention or prevention measures have been taken 16 . It is crucial to point out that, in situations which the violence of the aggression is very intense, it is not necessary to prove if the suffering of the victim lasted for six months (normally used as a parameter of evaluation).
As it can be observed, it is a very complex phenomenon, which involves cultural, social, legal and physical factors. When it is analyzed, we should be very cautious and consider those multiple aspects, taking into account since the legal context to the health one. It is also crucial that the harassed one should be treated by competent professionals, who are able to relate the damage and establish the causal link to the workplace. It is underlined that the causal link is related to the conditions in which the work is performed and not to the professional activity itself 11 .
The care proposed in the definition of the situations, which are configured as moral harassment, must be intensified when it is taken into account that some workers may not know that they are being harassed or they deny the existence of the situation, by attributing the clinical manifestations to personal problems. Many times, such fact is due to the lack of knowledge on that phenomenon. However, there are nuances to be considered, such as, for example, when the individual imagines that he is being harassed or simulates some situations to be indemnified 14 .
Therefore, WHO 4 emphasizes the need to distinguish healthy conflicts of bullying, to prevent any injustice both for workers and for employers. According to the organization, it is essential to draw a distinction between occasional clashes, open and frank strategies, honest communication, among others, and the situations of moral harassment, i.e., vertical arrangement of power, behavior boycott, mistaken strategies and indirect communication. Workers need to be aware of the main symptoms of moral harassment, which are bouts of unsoothable crying, insomnia, depression, thirst for revenge, feelings of worthlessness, decreased libido, digestive disorders, headaches, idea of suicide, early alcoholism, elevated blood pressure and dizziness 7 .
It is also necessary to consider that moral harassment is manifested differently in relation to gender and it stems from cultural components which are explained sociologically. Women are the ones who most suffer intimidation, submission, sick jokes, comments about their physical appearance or clothing; for men, nasty comments about their masculinity, ability to work and support the family are more common 17 .

Moral harassment amongst health professionals
With regard to the work of health professionals, it is essential to stress the need to be particular-Moral harassment, ethics and psychological stress in workplace Update Articles ly alert to possible situations of harassment, since their activities are, a priori, stressful. In addition, it should be noted as aggravating the hierarchical process of health services, which historically gives primacy to the doctors at the expense of other professional groups. In these circumstances, it is essential, therefore, to pay more attention to identify possible situations of moral harassment.
This requirement is applied with greater relevance to nursing, the category for which the scientific literature emphasizes the importance of learning to take care of them before taking care of others, to be able to provide care to patients and families 18 . In this approach, recognizing which is harmful, as moral harassment, is indispensable strategy to avoid it or minimize it, making life happier and full 19 . Besides the self-care, it is emphasized that the nurse is the leader of the nursing team and they may also be the leader of the multidisciplinary health care team. So they should be prepared to receive complaints from workers, identify possible situations of harassment in the work environment for their staff and also work actively with the teams and organizations in order that such violence does not become frequent or relegated to background The identification of these situations may not be so easy because moral harassment tends to occur covertly, as well as being subject to a covenant of silence and tolerance among professionals (the harassed, harassers and witnesses) 11 . A study developed in the Brazilian health services indicates this fact, because it was found that 38.5% of the victims of such violence took the initiative to call the immediate supervisor to report the incident. However, only in 20% of cases the reasonable steps were taken 20 .
It gathers that workers should be aware with the way to behave and communicate in the workplace. It is also important for employers to implement and value preventive programs for the health of worker, with a view to develop a healthy environment for physical and mental health of everyone and encourage the practice of self-care, ensuring, thus, a quality perspective of work life and an appropriate social life for the maintenance of health 21 .
It is also noteworthy that the university, as a space of freedom and autonomy of multidisciplinary interdisciplinary and transdisciplinary thought, plays a fundamental role in the production of information and education which provides the construction and the path of social agents in search of work and life with dignity and ethics. The civic education, which is aimed at equitable social proposals, also aims to bring out the real problems of labor world in defense of life and thus overcome the experiences marked by domination, strong coercion, fear, suffering, and submission, among others. The university has, therefore, the duty of always stimulating work environments which favor workers' health, disease prevention and the reduction of injuries 22 .
It is also necessary to reflect on the conception of the disease in the capitalist logic, in which the disease is seen as a central aspect, and subjectivity is not taken into account; for example, when an individual suffers, no one cares, but regarding their ability or inability to produce increasingly they do 23 . In Brazil there is also no labor law on the subject, although the bullying characterization exists. At the federal level, there are some bills on moral harassment and coercion [24][25][26] . The legal standards approved are restricted to civil service, and, mostly, they are state laws approved in Rio de Janeiro 27, São Paulo28, Rio Grande do Sul 29 and Minas Gerais 30, besides law projects in progress in other states 24 .

Legislation on moral harassment
It is denoted that, in public services, harassment is not usually associated with productivity, but to power struggles. In this context, the harassment is linked to a psychological dimension, in which envy and greed lead individuals to control the others and want to get rid of them 9. This can be directly linked to the lack of specific legislation, which does not determine the impunity of stalker or lack of protection of the professional harassed.
Although harassment is also typified in the regulation of some municipalities, it can be considered that its regulation is still incomplete, in view of the number of municipalities. Thus, it can be stated that, from 2001 to the present days, there are few laws on this subject adopted 24 . Thus, the updates are extremely important in the Brazilian legislation with the purpose of minimizing moral harassment in all functional levels in which it may happen.
It is emphasized that, for other workers, the general principles of law, the norms contained in the Moral harassment, ethics and psychological stress in workplace

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Constitution, the Civil Code and the Consolidation of Labor Laws (CLT) are applied. This legal framework seeks to ensure workers, in general, the right to a healthy work environment which constitutes a part of a well-structured organization that values well-being and quality of life of its employees 9 .
In the labor relations governed by Consolidation of Labor Laws, in addition to the employee, the employer (individual or entity) can also be held liable in cases of bullying when they do not prevent or counteract undesirable conduct. In this circumstance, the responsibility of the employer is subjective, by intent or fault, but with presumed guilt, so that the burden of proof is shifted, i.e., the employer must prove that he acted culpably 31 .
Other aspects of labor relations that are worth mentioning are the management power of the employer and the ignorance of worker.
The management power gives employers the direction of labor relations, within the legal limits, as natural characteristics of the relations between employee/employer. This includes the organization of work with disciplinary power over the employee, the organizing power of the activities of the employee in line with other production factors related to the company's goals, and the power control of the employer, which gives the right to inspect the work of the employee (disciplinary measures). 32 .
Thus, legitimate decisions of a labor relationship are guided (transference of sector, or activity, job or schedule changes etc.), as expressed in the contract of employment. Likewise, it is natural that the superior expresses constructive criticism and feedback of the work performed by his employees, since they are not used as punishment or retaliation 33 .
In parallel, when the worker do not know his duties and obligations as well as the management power of the employer, which are normal situations of a work process can be misinterpreted as bullying.
However, due to the peculiarities of this subject, its latest innovation as a moral category, the absence of comprehensive legislation to deal with the phenomenon and, mainly, the traditionalism of morality, which tends to insert work relations as they belonged to the submission of domination; it is essential to reflect on this nefarious aspect of the work environment, seeking thereby to provide new levels of democratic and healthy labor relations.
It is a fact that, besides the legal attention, the worker harassed needs support, mainly, from employing institutions, to prevent further damage. It is essential to recover their self-esteem and identity as subject-worker, by creating an environment in institutions which is compatible with the principles of citizenship.
Thus, a work environment which is guided in the dialogical communication and the rescue of humanization in the labor process brings the implicit principles of democratic society 13 . It should be reaffirmed nonviolence, equality of rights and equity in this environment, by practicing citizenship daily.

Final considerations
The effects of violence in the moral life of human beings are devastating, especially regarding the development of psycho-emotional disorders. It is essential to preserve the mental health of workers. One of the ways is to adopt prevention measures such as the creation of healthy environments and relationships of trust and fairness among people, the implementation of a code of ethics and/or conduct in the institutions, and training programs for the prevention of violent behavior in job.
The Federal Constitution is an effective means of protecting workers in relation to the principles and rights of citizens, the social values of work, free enterprise, equal rights and obligations between men and women and the avoidance of violation of honor and the image of the individual.
It is not an easy task to face the consequences of moral harassment. Fighting it is a necessity and requires the formation of a multidisciplinary collective, i.e., the participation of trade unions, lawyers, occupational doctors and nurses, sociologists, psychologists and anthropologists, among other professionals, who can create groups of reflection on this theme, providing a work environment with less risk and violence to workers.
Thus, it is clear that, in order to obtain a healthy work environment, labor conditions based on moral, ethical and respect for others must be achieved, by taking into account each individual as unique with their beliefs, values and culture. It is essential to revisit human values of all natures. There must be a collective commitment to ethics, solidarity, love of neighbor, dignity, appreciation of the self and the other, the citizenship and respect, above all, with life. With the awakening of these values, it is believed that moral harassment in the workplace can be mitigated and/or even excluded, causing less suffering to workers.