COE 1999 :SEMINAR Men and Violence

Elder abuse and older men:
towards an understanding

EuroPROFEM - The European Men Profeminist Network http://www.europrofem.org 

 

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European Council of Europen - Human Rights

Section Equality between women and men

Seminar : Men and Violence Against Women

Strasbourg, 8 October 1999 - Palais de l'Europe - France

 

Elder abuse and older men: towards an understanding

 

Ms Bridget PENHALE and Mr Jonathan PARKER,
University of Hull (United Kingdom)

 

Introduction

 

The main points that this paper addresses are as follows:

Elder abuse is a comparative newcomer to studies concerning violence

Much early research was gender absent/gender neutral

The problem is hidden; it is a taboo topic

“Naming” is importantThe forms that the violence takes may be slightly different from violence affecting other groups; there are a number of additional factors involved in elder abuse.

 

The growth of elder abuse

Interest in elder abuse and recognition of it as a social problem in need of attention, has developed in many countries in recent years. This has, however, been predominantly in the context of existing recognition of domestic violence and child abuse. This growth of interest in elder abuse shares a number of common features with these other areas of violence - slow recognition and acceptance; difficulties with definitions and concepts; an emphasis perhaps on stress and pathology as opposed to gender/power and male violence.

 

Other forms of violence had been identified as problems at earlier points in time (for example, in the UK child abuse was recognised from the late 1960s onwards and violence towards women from the early 1970s). Further, whereas child abuse and elder abuse were initially identified through professional concern, violence against younger women was identified through the women’s movement at a level of social action. This difference in social problem orientation may affect the development of responses and policies towards the various types of abuse. Elder abuse is, however, a comparative newcomer to the field of studies concerning violence, although it is nonetheless important than other areas of concern. 

 

An absence of gender

The early research studies that considered elder abuse were not particularly concerned with gender, and, following the classification developed by Hamner and Hearn (1999), could be described as either ‘gender absent’ or ‘gender neutral’. Initially, studies were ‘gender absent’ in that there was a failure to even consider gender as a factor of relevance within situations of elder abuse. The situation then developed to a point where gender was considered, and included within research studies, but was viewed as a factor among several others that warranted attention. It is this type that is referred to as ‘gender neutral’, as the potential effects of gender appear to be diluted within research and theoretical considerations. 

As an example of this, it is interesting to note that Pillemer and Suitor (1992) included the gender of the caregiver as an additional possible predictive variable in elder abuse. No hypotheses were made regarding gender in the research, however, and, whilst spousal violence was found to be more likely than between other relationships, no comments concerning gender were made in their subsequent discussion. This ungendered; gender neutral approach held sway until relatively recently (Whittaker, 1995, 1996).

 

Whittaker (1995) argues that research and theory construction occurs in a socio-political climate which privileges definition and prevalence studies above the gender debate. The main ‘gender neutral’ approaches she identifies include situational stress (focus on victims and is underpinned by stereotypical notions of ageing and dependency); pathology of abusers (considers a range of predisposing factors), and family violence (which reflects the intention to safeguard 'normal' family relationships).

 

 Accordingly, she states: 

'There appears to be no attempt to include the victim's subjective experience of abuse as part of the definitional debate and very little attention is paid to issues of inequality of power between victim and perpetrator other than to stress that old women are not children and that dependency exists as a two-way process within relationships and between them and their abusers. (Whittaker, 1996, p. 149)

 

Biggs, Phillipson and Kingston (1995) promoted a domestic violence approach to elder abuse that emphasised power imbalances and highlighted the position of victimised groups in society. Maintaining a clear distinction between victim and perpetrator is not always possible using this approach, however. This is seen in the Conflict Tactics Approach (Gelles and Straus, 1979; Gelles, 1993) which views conflict as constructed and maintained by both parties. The domestic violence approach to elder abuse focuses on violence as the central theme. This may lead to a reduced recognition of other forms of abuse and neglect (Biggs, Phillipson and Kingston, 1995). A corrective to this approach is seen in the 'domination' model of domestic violence, which focuses on the power of male aggressors (Yllo, 1993).

 

The family violence model was developed further in Bennett, Kingston, and Penhale, (1997). Family violence can be understood as violence which occurs in families and is perpetrated against the powerless and vulnerable. It is an aggressive act by a more powerful individual, group or institution against someone with less power. The perception of the power imbalance may not necessarily be at a conscious level. It develops from the patterns of interaction between individuals from which relative positions in terms of power are secured (see Hughes 1995). In these ways the family violence approach fits with the personal, cultural and structural model of oppression (Thompson, 1997, 1998). However, neither model can be viewed as wholly ‘gender present’ (Hamner and Hearn, 1999), and as we shall see, it is only comparatively recently that there has been a shift towards an inclusion of analysis in terms of gender considerations. 

Aitken and Griffin (1996), writing from a feminist perspective, suggest that elder abuse should be included as a category in domestic violence, but should emphasise a gender-power analysis:

 

‘.. the relationship between elder abuse and care and between elder abuse and family violence needs to be revisited. Neither care nor family violence by itself offers a sufficient explanation for elder abuse; a more over-arching was of thinking about elder abuse which would also allow an appropriate integration of gender issues would be in terms of power and dependency.' (p. 139) 

 

In situations of elder abuse there is likely to be a combination of complex sociological and psychological factors operating at and between structural, organisational, family and individual levels. Feminist perspectives focus on the role of gender and power within domestic violence. Social, political and economic processes are seen to support patriarchy in the subjugation of women. Violence represents the means men use to maintain positions of power at the societal, family and interpersonal levels. A range of causal factors must be brought to bear and individual differences and diversity recognised. The additional variable of age must be considered when discussing elder abuse.

 

A taboo topic

As suggested earlier, elder abuse is the most recent form of interpersonal violence to have been recognised as a problem in need of attention. It is also, however, an area that has been hidden from public concern and has been regarded as a ‘taboo topic’. Much of the abuse that occurs takes place behind closed doors and is not open to public scrutiny, as discussed elsewhere (Bennett et al, 1997). Making what happens in private, a matter for public concern is not an easy task, in part due to the resistance experienced from proponents of familial rights to privacy and freedom from state intervention. In addition, this is not a pleasant area to focus on, in particular as it challenges some of the myths and deeply held beliefs that have been constructed over time within and about society. Examples of such attitudes are that families provide warm, nurturing environments for individuals or that institutions are safe places for older people to live in. 

 

It has not been easy to challenge this taboo and such beliefs, nor to encourage people to discuss situations, let alone to disclose them. The sexual abuse of older women is an area that has proved extremely problematic to consider, largely due to the difficulty that many people have in conceptualising older people as sexual beings. It was difficult enough to raise issues concerning child sexual abuse in the early 1980s, for example, so to consider an older woman as subject of sexual violence may prove very difficult. Throughout the 1990s, issues concerning violence towards older people have been raised and the silence wrought by the taboo has been challenged and gradually eroded.

 

The importance of ‘naming’ Within the context of the hidden nature of the problem, the silencing that has occurred is understandable. Abusive situations that occur in private are not spoken about, and often not even recognised. Abusive situations that occur within institutions may, arguably, be less hidden but are equally likely to go un-named. It is important, therefore, that within the process of breaking the taboo, naming of the situation as abusive happens. Furthermore, that the situation should not be objectified but needs to be personalised, in order that the experiences of individuals can be properly attended to.

 

The power of language is important in this regard. Aitken and Griffin (1996) and Whittaker (1996) see degenderisation in elder abuse through the changes in terminology over a period of a decade, 1984-1994 from 'granny bashing' (Baker, 1977) to elder abuse (Bennett and Kingston, 1993), which masks the gender specificity of abuse. This type of change cannot simply be construed as a development away from stigmatising and patronising language, as it also has the effect of neutralising the fact that more older women experience abuse than men.

 

There is also recognition of a tendency towards an homogenisation of older people in research into elder abuse, which takes no account of individual differences and treats all older people as part of the same undifferentiated group. At the same time, such approaches obviously lack any appropriate consideration of gender differences. It is also necessary to consider what is being named and who is involved in the naming, so that situations are recognised and dealt with by the individuals who are involved by them, if at all possible. The meanings ascribed to situations by individuals and the construction of their understandings about situations and the processes involved are also necessary components of this, although research into this type of area is comparatively rare. The fact that elder abuse was first identified by professionals is of note here, as unlike the situation regarding violence towards young women, older people are notable by their absence from any discussion or debate concerning abuse and abusive situations unless cast in the role of ‘victim’, ‘abuser’ or concerned witness. 

 

Differing forms of abuse

 

Although there is an absence of agreed or standard definitions of abuse, commented on by McCreadie (1996) and others, most people concerned with the issue agree on the different types of abuse that can happen. These are physical abuse; sexual abuse; neglect; financial abuse (also referring to exploitation and misappropriation of an individual’s property and possessions); psychological and emotional abuse. To these may be added such categories as abandonment, enforced isolation and deprivation of necessary items for daily living (warmth, food or other aspects, such as teeth). Some of these types appear to be reasonably distinctive to older people: for example, neglect or financial abuse may occur in ways that are not commonly seen in situations concerning children or young women although abuse of younger disabled women may share similar features to that experienced by older people. 

 

Questions of numbers

 

Throughout the past decade, the literature on elder abuse has developed and burgeoned. Notwithstanding this, however, it is generally understood that males are more likely to abuse than women and that women are more likely to be abused than men within situations of elder abuse. At times this knowledge may lead to an inference that categorises and labels men as abusers/perpetrators and women as abused/victim. In a strict consideration of numerical terms this is clear, but there is a need for abuse to be understood from a wider perspective, viewed, perhaps, through a slightly different lens. This would demand attention to the context of abuse and abusive power relations in an unequal society including a consideration of women as abusers and men as abused.

 

It is perhaps timely to include within the understanding of abuse material of relevance from the theoretical frameworks of social psychology and labelling (Scheff, 1974). Within society, older men are generally associated with belligerence, perversion and the fears of ageing and decline. In this context the media and social organisation of welfare sets a discourse in which abuse is understood as behaviour which can be explained, if not condoned. By examining the construction of this discourse it is possible to throw new light on our understanding of abuse and its gendered directions.

 

Figures from research studies from all countries consistently suggest that women are more likely to be victims and men more likely to be abusers, but Wolf (1994) indicates that figure is only marginally higher than would be expected on the basis of female elders in the general population. McCreadie and Quigley (1999), from a UK perspective concerning an analysis of case records, indicate an increasing number of men who are abused in very old age (80+ years). If Straus' (1993) suggestion that violence by women to men is greatly under-reported, the link between gender and elder abuse may be less strong, but caution needs to be exerted here in order to consider a range of different, but inter-related factors.

 

Barnett, Miller-Perrin and Perrin (1997) review research concerning the characteristics of those who abuse and those who are abused. Results regarding gender are somewhat contradictory. Adult Protective Service figures from the USA reveal most victims are female (68%) (Tatara, 1993). In the earlier Boston survey the majority of victims were male (52%) (Pillemer and Finkelhor, 1988) whilst 65% of respondents were female. The victimisation rate for men at 5.1% is double that for women (2.5%) and the elderly population is disproportionately female.

 

It must be remembered, however, that women tend to sustain more serious abuse and injuries than men, which may mean that women are more likely to require treatment for their injuries and thus come to the attention of authorities. Also, males are more likely to be violent and to commit more serious violence than females. Miller and Dodder (1989) suggest that research indicates that males are more likely to use physical violence whilst females are more likely to be engage in neglectful acts that are more passive in nature.

 

Men are more likely to live with someone else, which may make abuse more likely as one of the risk factors for elder abuse concerns living with others (Barnett et al, 1997). This corresponds with research into the characteristics and profiles of abusers: frequently a relative, and who has lived with victim for a long time; usually adult children, spouses, grandchildren, siblings then other relatives (Tatara, 1993). Pillemer and Finkelhor, 1988) found that abuse by non-family members was rare: abuse was mainly between partners in later life (see also Halicka, 1995; Johns and Hydle, 1995).

 

Historically, elder abuse in domestic settings has been constructed as a problem between a female abuser and older parents - often a mother - within a caring context. Aitken's Northamptonshire study found, however, that male sons rather than husbands abused older women (Aitken and Griffin, 1996). Women were physically abused, men were psychologically abused. This perhaps reflects gendered behaviour, echoing the perpetuation of patriarchy in society. The literature abounds with references to 'dysfunctional families'. Whittaker (1996) believes that this perspective creates the view that elder abuse represents a symptom within a poorly functioning family, which therefore avoids introducing gender issues into the debate.

 

Interestingly, Kosberg (1998) cites evidence for the idea of a ‘pay back’ for previous abuses of power, so that a woman, or children who have been abused by a man at an earlier point in the family’s history may exact some form of revenge on the man in later life. Swedish researchers Grafstrom, Norberg and Wimblad (1992) found some evidence for this type of dynamic in their study of caregivers in Sweden. Jack (1994) however places female to female and female to male abuse within the context of exchange relationships within a dysfunctioning and oppressive society. 

 

In the contemporary social situation we see increasingly higher numbers of women at the top end of the age scale. Women tend to be poorer which affects their life choices. The health needs of older women are not considered in public policies and poverty and ill-health foster dependency and the potential to exploit. Added to this is the fact that many women live alone and social services departments target single people rather than couples. Also, it is not only those who receive care who are marginalised. Middle-aged women undertake the bulk of informal care. Many of these people have just relinquished the responsibility for caring for children and will be employed too.

 

Elder abuse, however, cannot be seen solely in the context of families and interpersonal relationships, as Jack (1994) points out. The fluid nature of power and the continuing prevalence of patriarchal assumptions are linked to abuse within the context of health and social care (Glendenning and Kingston, 1999). It is acknowledged that the social and health care agencies accountable for 'protective responsibility' may overtly or inadvertently abuse (Stevenson and Parsloe, 1993). In addition, Jack (1994) indicates that dependence, power and violation represent the currency of relationships within these agencies, and that mutual (albeit unequal) dependency, powerlessness and violation leads to, and maintains abuse by formal carers.

 

Social care - between the public and the private

 

Social and health care practitioners both support and control, thus wielding power in the private world of families from their position as agents of the State (Parker and Penhale, 1998). Working to protect others demands, in fact, the legitimate exercise of power in human situations. It is crucial to the professional development of practitioners that they command an understanding of power to work with their ‘protective responsibilities’ (Stevenson and Parsloe, 1993). It is clear that a large degree of power whether felt or not by individual practitioners, derives from the legislative base to their work. 

 

Additionally, practitioners may also be likely to have personal power in the eyes of those with whom they work: often the dispossessed, disenfranchised and vulnerable; those who are most marginalised and excluded from and by society. However, not only do practitioners exercise power; they too are bounded by and subject to power - of agency, state and legislation. It is also necessary to recognise, moreover, that service users may exercise power in their interactions with practitioners. They choose and refuse services; they challenge and resist, and at times they may act and react in ways that are abusive. The dual direction of abuse in old age has been acknowledged elsewhere (McCreadie, 1992)

 

The function of caring has been professionalised in health and welfare settings and is generally conceptualised as women's work (Jack, 1994). Illich (1977) used the term 'social iatrogenesis' to refer to the ways in which the organisation of care practices could lead to ill health by increasing stress and bureaucratising care. The social organisation of social and health care continues this process. Older people receive care rather than treatment. They are perceived and treated as passive recipients of care rather than active participants, centrally involved in an enterprise premised on partnership. This can be seen as potentially doubly stigmatising because a positive outcome is generally denied by such approaches. The emphasis is on the outcome and content rather than the process.

 

'The recognition of the powerlessness shared by old women and their female carers as a result of the combination of ageism and sexism within the professionalization of welfare, leads to new perspectives on abuse by formal carers, perceiving abuser and abused as powerless socially, organizationally and personally, locked together in a relationship of mutual, enforced dependency. The medium through which this socially-constructed powerlessness becomes the individual and collective abuse of elderly people takes place is the 'exchange relationship' of formal care.' (Jack, 1994, p. 79)

 

Exchange theory suggests that individuals act according to real and perceived benefits and costs of continuing a relationship (Frude, 1990). The most dependent is the least powerful. However, the least powerless may also seek to maximise gains and minimise contributions to be made to a relationship. The person cared for may be seen as an inconvenience and a subculture of abuse may arise in formal care-giving situations (see also Aitken and Griffin, 1996).

 

Jack (1994) uses Seligman's (1975) work on 'learned helplessness' to show that ageist stereotypes of dependence and increasing incompetence lead to the erosion of personal control in the context of formal care. Perceived powerlessness and dependency has been implicated in abusers in formal and informal settings.

 

Women carers predominate in the workforce and the work is subsequently devalued. Women who are cared for are also discriminated against. Jack (1994, p.89) states:

 

'...in order to ensure her dependency-needs are met, the old woman is compelled to surrender her claim to adult status to the female carer, whose limited status within the organisation depends on her complete possession of the caring role.'

 

The search for pathology has neglected formal carers and offered little in the way of theoretical understanding.

 

'...powerlessness among carers and cared for is the lock confining them within a relationship of dependency and violation...their mutual empowerment is the key to interdependency without subordination.' (Jack, 1994, p. 90)

 

It is possible that the Foucauldian metaphor of the 'panopticon' may be useful in connection with such considerations (Foucault, 1979). The panopticon was taken from an idea for prison design originated by Jeremy Bentham. All levels of the prison could be seen at all times and prisoners would not know whether or not they were being watched at any given time. Foucault suggests that social surveillance techniques operate in a similar way.

 

Such a perspective would also suggest that surveillance of social and health care agencies and institutions has developed in recent years. The recent development in the UK of continual assessment for service users and for staff development may engender feelings for both older recipients of care and of formal care staff of continued surveillance, of not being able to escape or resist effectively.

 

This would therefore set the scene for the creation and maintenance of dependence and marginalisation by encouraging learned helplessness and submission to the power of surveillance. Disciplinary practices in use within health and social care agencies contribute to the operation of power through techniques of visibility. Additionally, designs aimed at maximum surveillance are used, and the processing, filing, creation and maintenance of individual cases perpetuates the situation. Divisions are created by binary distinctions such as practitioner and client, old and young, healthy and unhealthy, abuser and abused, male and female and the subject begins to watch over and monitor the self (Fawcett, 1996).

 

In the contemporary arena of social and health care, numerous strategies have been developed to regulate the imposition of power. These include judicial review, the development of law centres and advice bureaux (Trotter, 1999). Competition and inspection in public sector services has demanded a shift from casework to practice that is measurable and verifiable. This kind of regulation sets up its own discourse and is, itself, a form of power.

 

Control over resources is an important dynamic of power when considering the allocation of social and health care. Service users are often faced with stark perceived choices when the practitioner or agency is assumed able to offer and withdraw services at will. The potential of the institution and agency to abuse directly and the replication of an abusive system are now being given serious consideration (Goffman, 1968; Stanley, Manthorpe and Penhale, 1999).

 

Multiple forms of disadvantage

Recent perspectives explicitly incorporate the role of gender, race and class in influencing power dynamics. Ragin and Sunstrom (1989) suggest that sex-role socialisation leads to the adoption and expectation of stereotypical roles, which lead women to be perceived as lacking in power at organisational, sociocultural and interpersonal levels. Rosspenda, Richman, and Nawyn (1998) add race and class issues to gender in traditional models of sexual harassment as a consequence of power differentials based on location or status differences between men and women. Their research found the confluence of race, class and gender to be especially important where the target of the harassment has greater organisational power than the perpetrator.

 

Kukli and Breli (1997) employ a social exchange theory perspective to make the valuable point that prospective dependency may change marital power relationships in later life. Askham (1995) suggests, however, that gender-power differences continue in later life marriages. These analyses are much akin to Thompson's (1997, 1998) Personal, Cultural and Structural (PCS) model for theorising discrimination and oppression. The influences of personal prejudice with organisational culture and social structures are linked together by Thompson in a complex and continually changing way, resulting, he suggests, in oppressive practices.

 

Power is, of course, central to issues of gender. Mullender (1997) states that it is impossible to understand the personal and social world without taking a gendered perspective. Gender represents a social construction (Berger and Luckman, 1966). That is, gender relates to the roles, tasks, positions and assumptions associated with male and female within a particular social context. These roles and assumptions are internalised by those brought up within that society. Acting according to the ways a society prescribes inhibits resistance to oppression and recreates the social construction of gender.

 

Sexism does not refer solely to the prejudice expressed by individual males. It results also from the social structures developed to perpetuate a gendered ordering of society and the ways in which agencies and organisations reflect this order and instil normative roles and expectations into members. Sexism and the unequal distribution of power and roles in society can be linked with other forms of oppression leading to the necessity of a gender power analysis, which places gender within a wider socio-political context. For instance, child care is seen as the role of women as are care in the community and low paid care jobs in residential homes.

 

It is not only race, class and gender that interact, however. The social construction of ageing as negative and stigmatising is important (Bytheway, 1994). Aitken and Griffin (1996) remind us that there are proportionately more women than men in the general population the older that population becomes. Older women are marginalised in society on the grounds of gender and age. The negative connotations of ageism and ideas of dependency and impairment aggregate in the negotiations of power within society. Ageism, sexism and structural divisions combine to create power imbalances that are predicated on the notion of women as of inferior status. This facilitates the conditions in which abuse flourishes and militates against easy or quick resolution.

 

Ageism may be of further importance within such considerations as a ‘master’ category (Bytheway, 1994). Such multiple forms of disadvantage are of significance too, since they may not assist in any movement towards resolution of the problem, or, indeed, prevention. In addition, we can see that older women may face several distinct but overlapping areas of risk and disadvantage, perhaps even of jeopardy (Penhale and Kingston, 1995) and that these may be either singular or cumulative in their effect. 

 

Towards a gendered analysis

Feminist theories of elder abuse move beyond the health and welfare debates to a theory in which age and gender and the relationships between them and other social divisions are given equal importance. The potential for violence and abuse is fundamental to gender and power in all social relationships.

 

'A feminist analysis of elder abuse, whilst recognising the gendered nature of inequality, would have to acknowledge women's capacity for violence and recognise that the issue of power is more problematic and less fixed than previously imagined. The connections between relations of age, gender and power would be central categories of analysis and the notion of power would require a different treatment.

 

'This means treating power like age and gender relations as something fluid, rather than fixed and monolithic, as something which varies according to what it is in relation to or with.' (Whittaker, 1996, p. 152)

 

There is generally a lack of such a feminist critique of elder abuse although gender relations have been seen as central to examinations of child physical abuse (Featherstone, 1997). The concept of domination rather than power has been employed to demonstrate its significance. Research concerning domestic violence and the development of interagency working places necessary emphasis on domestic violence towards adult women and children. Older women are generally not included within such considerations, although the research does not explicitly exclude them (Hague and Malos, 1998). There is, however, a marginalisation of older people and an uncritical reinforcement of hierarchies of concern that reflects sociocultural power relations. Whittaker (1996) advocates a methodology of inclusion in participative research about elder abuse, which, she states, cannot be divorced from its social context and the patriarchal rather than pathological family. It is crucial, of course, that older people themselves are fully included as central actors within such developments.

 

Feminist analyses start with gender. The marginalisation of older people and, in particular, older women in society is taken into account. The patriarchal context sees men as having access to greater power over the more vulnerable and less powerful and being protected by societal norms. Whittaker (1996) therefore reframes the allegedly controlling characteristics and behaviours of non-compliant dependent victims as a struggle and resistance against oppression and male control. This moves away from explanations based on caregiver stress that have developed within the field of elder abuse and neglect and that absolve the perpetrator of responsibility.

 

Gelles (1993) suggests that feminist theory presents an analysis of only one type of violence and victimisation. It does not, in his view, account for child abuse, sibling abuse, violence by women or the abuse of older people. Featherstone (1997) disagrees with Gelles' analysis and suggests that in fact great differences and divergences now characterise feminisms. What the critiques by Gelles and Straus appear to fail to take into account are considerations of the interactions between different factors within feminist analyses.

 

When gender is seen as a constructed sociocultural process rather than biologically determined as 'sex', it is no longer enough to consider that males are violent, and women are peaceful and nurturing. Appropriate use of the former approach highlights diversity and rejects the attempt to define one sole cause of women's oppression.

 

 

Featherstone (1997, p. 431) argues for:

 

'...an engagement with some of the perspectives... characterized by an appreciation that gendered positions are significant explanatory tools in exploring violence but that these positions are neither fixed nor inevitable. They are subject to constant struggle and redefinition.'

 

At first sight, it may seem obvious and uncontroversial that gender and power issues are central to elder abuse. However, they relate and interrelate in extremely complex ways. For instance, we cannot blame one single aspect of gender or power relations for the development of violence and aggression between humans. It is not enough to say that elder abuse is perpetrated by damaged, sick or stressed individuals – namely men -or that attitudes that allow the continuation of elder abuse simply result from personal prejudice. We must now consider the complex interplay of structural power relations throughout society as setting the context for abuse to be minimised condoned, exacerbated or even perpetrated. 

 

However, this wider social explanation is also, in itself, insufficient. It is necessary to examine the organisational, agency and cultural factors reflecting the social structures, which encourage maintenance of the status quo in respect of gender divided roles, work and status. The socialisation of individuals in families is created by the wider social structures and cultural factors and, in turn, recreates them by subscribing to the gender and power games advanced. All these interact to produce individual experiences and behaviours some of which are fundamentally abusive and proscribed by society, some of which are neither condoned nor proscribed and some of which are perpetuated within the existing social fabric. This is often internalised by individuals who then add to the maintenance and development of a gendered and unequal society.

 

It is the social organisation of gender that allocates roles and meaning and which contributes to the marginalisation of elder abuse at a social, agency and personal level. As Thompson (1997) states in respect of anti-discriminatory practice, those who are not actively seeking to change this state of affairs are part of the problem. It is the responsibility of us all, therefore, as practitioners or simply as citizens, to acknowledge our own assumptions and gendered positions. We must work with agencies and organisations and the wider society to develop an approach that recognises the importance of gender and power relations and seek to influence those who set the terms of the argument at policy-making and political levels. As Kaufman (1994, p. 146) indicated, 'we all experience power in diverse ways, some that celebrate life and diversity and others that hinge on control and domination'. A gender-power analysis can be usefully employed to develop approaches that celebrate life and diversity in our attempts to deal with elder abuse.

 

Bibliography

 

Aitken, L. and Griffin, G. (1996) Gender and Elder Abuse, London: Sage.

 

Arber, S. and Ginn, J. (1995) (Eds.) Connecting gender and ageing: sociological approaches to gender relations in later life, Buckingham: Open University Press.

 

Askham, J. (1995) “The married lives of older people”, in Arber, S. and Ginn, J. (Eds.) Connecting Gender and Ageing. A sociological approach to gender relations in later life, Buckingham: Open University Press. 

Baker, A. A. (1977) “Granny battering”, Modern Geriatrics, 5, (8): 20-4 

Barnett, O., Miller-Perrin, C. and Perrin, R. (1997) Family Violence across the Lifespan. An Introduction. Thousand Oaks, Ca: Sage.

 

Bennett, G. and Kingston, P. (1993) Elder Abuse: Theories, Concepts and Interventions, London: Chapman and Hall.

 

Bennett, G., Kingston, P. and Penhale, B. (1997) The Dimensions of elder abuse: Perspectives for the practitioner. Basingstoke: Macmillan.

 

Berger, P. and Luckman, T. (1966) The Social Construction of Reality, London: Allen Lane.

 

Biggs, S.; Phillipson, C. and Kingston, P. (1995) Elder Abuse in Perspective, Buckingham: Open University.

 

Bytheway, B. (1994) Ageism, Buckingham: Open University Press.

 

Fawcett, B. (1996) “Women, mental health and community care: an abusive combination?” in Fawcett, B., Featherstone, B., Hearn, J. and Toft, C. (Eds.) Violence and Gender Relations. Theories and Interventions, London: Sage. 

Featherstone, B. (1997) “What has gender got to do with it? Exploring physically abusive behaviour towards children”, British Journal of Social Work, 27, 3, pp. 419-33. 

Foucault, M. (1977) Discipline and Punishment: the birth of the prison London: Tavistock.

 

Frude, N. (1990) Understanding Family Problems: a psychological approach, Chichester: John Wiley and Sons.

 

Gelles, R. (1993) “Through a sociological lens: social structure and family violence”, in Gelles, R. and Loseke, D. (Eds.) Current Controversies on Family Violence, London: Sage. 

Gelles, R. and Straus, M. (1979) “Violence in the American family” Journal of Social Issues, 35 (2): 15-39. 

Glendenning, F. and Kingston, P. (1999) Elder Abuse and Neglect in Residential Settings: different national backgrounds and similar responses, New York: Haworth Maltreatment and Trauma Press.

 

Goffman, E. (1961) Asylums: essays on the social situation of mental patients and other inmates, Reading: Penguin.

 

Grafstrom, M., Norberg, A. and Wimblad, B. (1992) “Abuse is in the eye of the beholder. Reports by family members about abuse of demented persons in home care. A total population based study”, Scandinavian Journal of Social Medicine. 24, 4: 247-55. 

Hague, G. and Malos, E. (1998) “Interagency approaches to domestic violence and the role of social services”, British Journal of Social Work, 28, 3: 369-86. 

Halicka, M. (1995) “Elder abuse and neglect in Poland”, Journal of Elder Abuse and Neglect. 6: 157-69. 

Hamner, J. and Hearn, J. (1999) “Gender and Welfare research” in Williams, F., Popay, J. and Oakley, A. (Eds.) Welfare research: A critical review London: UCL Press. 

Hughes, B, (1995) Older people and community care, Buckingham: Open University Press.

 

Illich, I.; Zola, I. K.; McKnight, J.; Caplan, J. and Shaiken, H. (1974) Disabling Professions, London: Marion Boyars.

 

Jack, R. (1994) “Dependence, power and violation; gender issues in the abuse of elderly people by formal carers” in Eastman, M. (1994) (Ed.) Old Age Abuse, London: Chapman Hall. 

Johns, S., and Hydle, I. (1995) “Norway: Weakness in Welfare” Journal of Elder Abuse and Neglect. 6, 3-4, 139-156. 

Kaufman, M. (1994) “Men, feminism, and men's contradictory experiences of power”, in Brod, H. and Kaufman, M. (Eds.) Theorizing Masculinities, Thousand Oaks, CA.: Sage. 

Kosberg, J. (1998) “Abuse of Elderly Men” Journal of Elder Abuse and Neglect. 9, 3, 69-88. 

Kulik, L. and Breli, H. (1997) “Continuity and discontinuity in attitudes towards marital power relations: pre-retired vs. retired husbands”, Ageing and Society, 17, 5, p. 571-95. 

McCreadie, C. (1992) Elder abuse: an exploratory study, London; HMSO

 

McCreadie, C. (1996) Elder abuse: an Update on research, London: HMSO.

 

McCreadie, C. and Quigley, L. (1999) “Figuring out Adult Abuse”, Community Care, 1258, 4-10 February, 24-25. 

Miller, R. B. and Dodder, R. A. (1989) "The Abused: Abuser Dyad; Elder Abuse in the State of Florida" in Filinson, R. and Ingman, S. R. (Eds.) (1989) Elder Abuse: Practice and Policy, New York: Human Sciences Press.

 

Mullender, A. (1997) Rethinking Domestic Violence: the social work and probation response, London: Routledge.

 

Penhale, B. (1993) "The Abuse of Elderly People: Considerations for Practice", British Journal of Social Work, 23, 2, 95-112.

 

Penhale, B. and Kingston, P. (1995) “Social Perspectives and elder abuse” in Kingston, P. and Penhale, B. (1995) (Eds.) Family Violence and the Caring Professions, Basingstoke: Macmillan. 

Parker, J. and Penhale, B. (1998) Protecting People, London: OLF/BASW.

 

Pillemer, K. A. (1986) "Risk factors in elder abuse: Results from a case-control study" in Pillemer, K. A. and Wolf, R. S. (Eds.) (1986) Elder Abuse: conflict in the family, Dover, Massachusetts: Auburn House.

 

Pillemer, K. A. and Wolf, R. S. (Eds.) (1986) Elder Abuse: conflict in the family, Dover, Massachusetts, Auburn House.

 

Pillemer, K. A. and Finkelhor, D. (1988) "The prevalence of elder abuse: A random sample survey," Gerontologist, 28 (1): 51-57.

 

Pillemer, K. A. and Suitor, J. J. (1992) “Violence and violent feelings. What causes them among family caregivers?” Journal of Gerontology: Social Sciences. 4, 7: S165-72. 

Ragin, B. and Sunstrom, E. (1989) “Gender and power in organisations: a longitudinal perspective”, Psychological Bulletin, 105, pp. 51-88 

Rosspenda, K. M., Richman, J. A. and Nawyn, S. J. (1998) “Doing power: the confluence of gender, race, and class in contrapower harassment”, Gender and Society, 12, 1, pp. 40-60. 

Scheff, T. (1974) “The Labelling Theory of Mental Illness”, American Sociological Review 39, (June), 444-452. 

Seligman, M. (1975) Helplessness, San Francisco, Ca: W.H. Freeman.

 

Stanley, N.; Manthorpe, J. and Penhale, B. (1999) (Eds.) Institutional abuse: perspectives across the lifecourse, London: Routledge.

 

Stevenson, O. and Parsloe, P. (1993) Community care and empowerment, York: Joseph Rowntree Foundation.

 

Straus, M. (1993) “Physical assaults by wives – a major social problem”, in R. Gelles, R. and Loseke, D. (Eds.) Current Controversies on Family Violence. Newbury Park, Ca: Sage. 

Tatara, T. (1993) “Finding the nature and scope of domestic elder abuse with state aggregate data”, Journal of Elder Abuse and Neglect, 5 (4): 35-6. 

Thompson, N. (1997) Anti-discriminatory Practice, (2nd ed.) Basingstoke: Macmillan.

 

Thompson, N. (1998) Promoting Equality, Basingstoke: Macmillan.

 

Trotter, C. (1999) Working with Involuntary Clients, London: Sage.

 

Whittaker, T. (1995) “Gender and elder abuse”, in Arber, S. and Ginn, J. (1995) (Eds.) Connecting gender and ageing: sociological approaches to gender relations in later life, Buckingham, Open University Press. 

Whittaker, T. (1996) “Elder abuse”, in Fawcett, B., Featherstone, B., Hearn, J. and Toft, C. (Eds.) Violence and Gender Relations. Theories and Interventions, London: Sage. 

Wolf, R. (1994) “Responding to Elder Abuse in the USA” in Action on Elder Abuse Working Paper No.1: A report on the proceedings of the 1st International Symposium on Elder Abuse, London: Action on Elder Abuse. 

Yllo, K. (1993) “Through a feminist lens: gender, power and violence” in Gelles, R. and Loseke, D. (1993) (Eds.) Current Controversies in Family Violence, Newbury Park, Ca: Sage.

 

 

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Summary

COE 1999 : SEMINAR
MEN AND VIOLENCE AGAINST WOMEN

EuoPROFEM - The European Men Profeminist Network http://www.europrofem.org 

 

 


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European Council of Europe - Human Rights
Section Equality between women and men
Strasbourg, 8 October 1999
Palais de l'Europe - Strasbourg France

  Contact: Olof Olafsdottir

Elder abuse and older men:
towards an understanding

 

Ms Bridget PENHALE and Mr Jonathan PARKER,
University of Hull (United Kingdom)

 

 

Introduction

The main points that this paper addresses are as follows:

Elder abuse is a comparative newcomer to studies concerning violence

Much early research was gender absent/gender neutral

The problem is hidden; it is a taboo topic

“Naming” is important

The forms that the violence takes may be slightly different from violence affecting other groups; there are a number of additional factors involved in elder abuse.

 

 

The growth of elder abuse

Interest in elder abuse and recognition of it as a social problem in need of attention, has developed in many countries in recent years. This has, however, been predominantly in the context of existing recognition of domestic violence and child abuse. This growth of interest in elder abuse shares a number of common features with these other areas of violence - slow recognition and acceptance; difficulties with definitions and concepts; an emphasis perhaps on stress and pathology as opposed to gender/power and male violence.

 

 

Other forms of violence had been identified as problems at earlier points in time (for example, in the UK child abuse was recognised from the late 1960s onwards and violence towards women from the early 1970s). Further, whereas child abuse and elder abuse were initially identified through professional concern, violence against younger women was identified through the women’s movement at a level of social action. This difference in social problem orientation may affect the development of responses and policies towards the various types of abuse. Elder abuse is, however, a comparative newcomer to the field of studies concerning violence, although it is nonetheless important than other areas of concern.

 

 

 

An absence of gender

The early research studies that considered elder abuse were not particularly concerned with gender, and, following the classification developed by Hamner and Hearn (1999), could be described as either ‘gender absent’ or ‘gender neutral’. Initially, studies were ‘gender absent’ in that there was a failure to even consider gender as a factor of relevance within situations of elder abuse. The situation then developed to a point where gender was considered, and included within research studies, but was viewed as a factor among several others that warranted attention. It is this type that is referred to as ‘gender neutral’, as the potential effects of gender appear to be diluted within research and theoretical considerations.

 

As an example of this, it is interesting to note that Pillemer and Suitor (1992) included the gender of the caregiver as an additional possible predictive variable in elder abuse. No hypotheses were made regarding gender in the research, however, and, whilst spousal violence was found to be more likely than between other relationships, no comments concerning gender were made in their subsequent discussion. This ungendered; gender neutral approach held sway until relatively recently (Whittaker, 1995, 1996).

 

Whittaker (1995) argues that research and theory construction occurs in a socio-political climate which privileges definition and prevalence studies above the gender debate. The main ‘gender neutral’ approaches she identifies include situational stress (focus on victims and is underpinned by stereotypical notions of ageing and dependency); pathology of abusers (considers a range of predisposing factors), and family violence (which reflects the intention to safeguard 'normal' family relationships). Accordingly, she states:

 

'There appears to be no attempt to include the victim's subjective experience of abuse as part of the definitional debate and very little attention is paid to issues of inequality of power between victim and perpetrator other than to stress that old women are not children and that dependency exists as a two-way process within relationships and between them and their abusers. (Whittaker, 1996, p. 149)

 

Biggs, Phillipson and Kingston (1995) promoted a domestic violence approach to elder abuse that emphasised power imbalances and highlighted the position of victimised groups in society. Maintaining a clear distinction between victim and perpetrator is not always possible using this approach, however. This is seen in the Conflict Tactics Approach (Gelles and Straus, 1979; Gelles, 1993) which views conflict as constructed and maintained by both parties. The domestic violence approach to elder abuse focuses on violence as the central theme. This may lead to a reduced recognition of other forms of abuse and neglect (Biggs, Phillipson and Kingston, 1995). A corrective to this approach is seen in the 'domination' model of domestic violence, which focuses on the power of male aggressors (Yllo, 1993).

 

The family violence model was developed further in Bennett, Kingston, and Penhale, (1997). Family violence can be understood as violence which occurs in families and is perpetrated against the powerless and vulnerable. It is an aggressive act by a more powerful individual, group or institution against someone with less power. The perception of the power imbalance may not necessarily be at a conscious level. It develops from the patterns of interaction between individuals from which relative positions in terms of power are secured (see Hughes 1995). In these ways the family violence approach fits with the personal, cultural and structural model of oppression (Thompson, 1997, 1998). However, neither model can be viewed as wholly ‘gender present’ (Hamner and Hearn, 1999), and as we shall see, it is only comparatively recently that there has been a shift towards an inclusion of analysis in terms of gender considerations.

 

Aitken and Griffin (1996), writing from a feminist perspective, suggest that elder abuse should be included as a category in domestic violence, but should emphasise a gender-power analysis:

 

‘.. the relationship between elder abuse and care and between elder abuse and family violence needs to be revisited. Neither care nor family violence by itself offers a sufficient explanation for elder abuse; a more over-arching was of thinking about elder abuse which would also allow an appropriate integration of gender issues would be in terms of power and dependency.' (p. 139)

 

In situations of elder abuse there is likely to be a combination of complex sociological and psychological factors operating at and between structural, organisational, family and individual levels. Feminist perspectives focus on the role of gender and power within domestic violence. Social, political and economic processes are seen to support patriarchy in the subjugation of women. Violence represents the means men use to maintain positions of power at the societal, family and interpersonal levels. A range of causal factors must be brought to bear and individual differences and diversity recognised. The additional variable of age must be considered when discussing elder abuse.

 

A taboo topic

As suggested earlier, elder abuse is the most recent form of interpersonal violence to have been recognised as a problem in need of attention. It is also, however, an area that has been hidden from public concern and has been regarded as a ‘taboo topic’. Much of the abuse that occurs takes place behind closed doors and is not open to public scrutiny, as discussed elsewhere (Bennett et al, 1997). Making what happens in private, a matter for public concern is not an easy task, in part due to the resistance experienced from proponents of familial rights to privacy and freedom from state intervention.   In addition, this is not a pleasant area to focus on, in particular as it challenges some of the myths and deeply held beliefs that have been constructed over time within and about society. Examples of such attitudes are that families provide warm, nurturing environments for individuals or that institutions are safe places for older people to live in.

 

It has not been easy to challenge this taboo and such beliefs, nor to encourage people to discuss situations, let alone to disclose them. The sexual abuse of older women is an area that has proved extremely problematic to consider, largely due to the difficulty that many people have in conceptualising older people as sexual beings. It was difficult enough to raise issues concerning child sexual abuse in the early 1980s, for example, so to consider an older woman as subject of sexual violence may prove very difficult. Throughout the 1990s, issues concerning violence towards older people have been raised and the silence wrought by the taboo has been challenged and gradually eroded.

 

The importance of ‘naming’

Within the context of the hidden nature of the problem, the silencing that has occurred is understandable. Abusive situations that occur in private are not spoken about, and often not even recognised. Abusive situations that occur within institutions may, arguably, be less hidden but are equally likely to go un-named. It is important, therefore, that within the process of breaking the taboo, naming of the situation as abusive happens. Furthermore, that the situation should not be objectified but needs to be personalised, in order that the experiences of individuals can be properly attended to.

 

The power of language is important in this regard. Aitken and Griffin (1996) and Whittaker (1996) see degenderisation in elder abuse through the changes in terminology over a period of a decade, 1984-1994 from 'granny bashing' (Baker, 1977) to elder abuse (Bennett and Kingston, 1993), which masks the gender specificity of abuse. This type of change cannot simply be construed as a development away from stigmatising and patronising language, as it also has the effect of neutralising the fact that more older women experience abuse than men.

 

There is also recognition of a tendency towards an homogenisation of older people in research into elder abuse, which takes no account of individual differences and treats all older people as part of the same undifferentiated group. At the same time, such approaches obviously lack any appropriate consideration of gender differences. It is also necessary to consider what is being named and who is involved in the naming, so that situations are recognised and dealt with by the individuals who are involved by them, if at all possible. The meanings ascribed to situations by individuals and the construction of their understandings about situations and the processes involved are also necessary components of this, although research into this type of area is comparatively rare. The fact that elder abuse was first identified by professionals is of note here, as unlike the situation regarding violence towards young women, older people are notable by their absence from any discussion or debate concerning abuse and abusive situations unless cast in the role of ‘victim’, ‘abuser’ or concerned witness.

 

Differing forms of abuse

Although there is an absence of agreed or standard definitions of abuse, commented on by McCreadie (1996) and others, most people concerned with the issue agree on the different types of abuse that can happen. These are physical abuse; sexual abuse; neglect; financial abuse (also referring to exploitation and misappropriation of an individual’s property and possessions); psychological and emotional abuse. To these may be added such categories as abandonment, enforced isolation and deprivation of necessary items for daily living (warmth, food or other aspects, such as teeth). Some of these types appear to be reasonably distinctive to older people: for example, neglect or financial abuse may occur in ways that are not commonly seen in situations concerning children or young women although abuse of younger disabled women may share similar features to that experienced by older people.

 

Questions of numbers

Throughout the past decade, the literature on elder abuse has developed and burgeoned. Notwithstanding this, however, it is generally understood that males are more likely to abuse than women and that women are more likely to be abused than men within situations of elder abuse. At times this knowledge may lead to an inference that categorises and labels men as abusers/perpetrators and women as abused/victim. In a strict consideration of numerical terms this is clear, but there is a need for abuse to be understood from a wider perspective, viewed, perhaps, through a slightly different lens. This would demand attention to the context of abuse and abusive power relations in an unequal society including a consideration of women as abusers and men as abused.

 

It is perhaps timely to include within the understanding of abuse material of relevance from the theoretical frameworks of social psychology and labelling (Scheff, 1974). Within society, older men are generally associated with belligerence, perversion and the fears of ageing and decline. In this context the media and social organisation of welfare sets a discourse in which abuse is understood as behaviour which can be explained, if not condoned. By examining the construction of this discourse it is possible to throw new light on our understanding of abuse and its gendered directions.

 

Figures from research studies from all countries consistently suggest that women are more likely to be victims and men more likely to be abusers, but Wolf (1994) indicates that figure is only marginally higher than would be expected on the basis of female elders in the general population. McCreadie and Quigley (1999), from a UK perspective concerning an analysis of case records, indicate an increasing number of men who are abused in very old age (80+ years). If Straus' (1993) suggestion that violence by women to men is greatly under-reported, the link between gender and elder abuse may be less strong, but caution needs to be exerted here in order to consider a range of different, but inter-related factors.

 

Barnett, Miller-Perrin and Perrin (1997) review research concerning the characteristics of those who abuse and those who are abused. Results regarding gender are somewhat contradictory. Adult Protective Service figures from the USA reveal most victims are female (68%) (Tatara, 1993). In the earlier Boston survey the majority of victims were male (52%) (Pillemer and Finkelhor, 1988) whilst 65% of respondents were female. The victimisation rate for men at 5.1% is double that for women (2.5%) and the elderly population is disproportionately female.

 

It must be remembered, however, that women tend to sustain more serious abuse and injuries than men, which may mean that women are more likely to require treatment for their injuries and thus come to the attention of authorities. Also, males are more likely to be violent and to commit more serious violence than females. Miller and Dodder (1989) suggest that research indicates that males are more likely to use physical violence whilst females are more likely to be engage in neglectful acts that are more passive in nature.

 

Men are more likely to live with someone else, which may make abuse more likely as one of the risk factors for elder abuse concerns living with others (Barnett et al, 1997). This corresponds with research into the characteristics and profiles of abusers: frequently a relative, and who has lived with victim for a long time; usually adult children, spouses, grandchildren, siblings then other relatives (Tatara, 1993). Pillemer and Finkelhor, 1988) found that abuse by non-family members was rare: abuse was mainly between partners in later life (see also Halicka, 1995; Johns and Hydle, 1995).

 

Historically, elder abuse in domestic settings has been constructed as a problem between a female abuser and older parents - often a mother - within a caring context. Aitken's Northamptonshire study found, however, that male sons rather than husbands abused older women (Aitken and Griffin, 1996). Women were physically abused, men were psychologically abused. This perhaps reflects gendered behaviour, echoing the perpetuation of patriarchy in society. The literature abounds with references to 'dysfunctional families'. Whittaker (1996) believes that this perspective creates the view that elder abuse represents a symptom within a poorly functioning family, which therefore avoids introducing gender issues into the debate.

 

Interestingly, Kosberg (1998) cites evidence for the idea of a ‘pay back’ for previous abuses of power, so that a woman, or children who have been abused by a man at an earlier point in the family’s history may exact some form of revenge on the man in later life. Swedish researchers Grafstrom, Norberg and Wimblad (1992) found some evidence for this type of dynamic in their study of caregivers in Sweden. Jack (1994) however places female to female and female to male abuse within the context of exchange relationships within a dysfunctioning and oppressive society.

 

In the contemporary social situation we see increasingly higher numbers of women at the top end of the age scale. Women tend to be poorer which affects their life choices. The health needs of older women are not considered in public policies and poverty and ill-health foster dependency and the potential to exploit. Added to this is the fact that many women live alone and social services departments target single people rather than couples. Also, it is not only those who receive care who are marginalised. Middle-aged women undertake the bulk of informal care. Many of these people have just relinquished the responsibility for caring for children and will be employed too.

 

Elder abuse, however, cannot be seen solely in the context of families and interpersonal relationships, as Jack (1994) points out. The fluid nature of power and the continuing prevalence of patriarchal assumptions are linked to abuse within the context of health and social care (Glendenning and Kingston, 1999). It is acknowledged that the social and health care agencies accountable for 'protective responsibility' may overtly or inadvertently abuse (Stevenson and Parsloe, 1993). In addition, Jack (1994) indicates that dependence, power and violation represent the currency of relationships within these agencies, and that mutual (albeit unequal) dependency, powerlessness and violation leads to, and maintains abuse by formal carers.

 

Social care - between the public and the private

Social and health care practitioners both support and control, thus wielding power in the private world of families from their position as agents of the State (Parker and Penhale, 1998). Working to protect others demands, in fact, the legitimate exercise of power in human situations. It is crucial to the professional development of practitioners that they command an understanding of power to work with their ‘protective responsibilities’ (Stevenson and Parsloe, 1993). It is clear that a large degree of power whether felt or not by individual practitioners, derives from the legislative base to their work.

 

Additionally, practitioners may also be likely to have personal power in the eyes of those with whom they work: often the dispossessed, disenfranchised and vulnerable; those who are most marginalised and excluded from and by society. However, not only do practitioners exercise power; they too are bounded by and subject to power - of agency, state and legislation. It is also necessary to recognise, moreover, that service users may exercise power in their interactions with practitioners. They choose and refuse services; they challenge and resist, and at times they may act and react in ways that are abusive. The dual direction of abuse in old age has been acknowledged elsewhere (McCreadie, 1992)

 

The function of caring has been professionalised in health and welfare settings and is generally conceptualised as women's work (Jack, 1994). Illich (1977) used the term 'social iatrogenesis' to refer to the ways in which the organisation of care practices could lead to ill health by increasing stress and bureaucratising care. The social organisation of social and health care continues this process. Older people receive care rather than treatment. They are perceived and treated as passive recipients of care rather than active participants, centrally involved in an enterprise premised on partnership. This can be seen as potentially doubly stigmatising because a positive outcome is generally denied by such approaches. The emphasis is on the outcome and content rather than the process.

 

'The recognition of the powerlessness shared by old women and their female carers as a result of the combination of ageism and sexism within the professionalization of welfare, leads to new perspectives on abuse by formal carers, perceiving abuser and abused as powerless socially, organizationally and personally, locked together in a relationship of mutual, enforced dependency. The medium through which this socially-constructed powerlessness becomes the individual and collective abuse of elderly people takes place is the 'exchange relationship' of formal care.' (Jack, 1994, p. 79)

 

Exchange theory suggests that individuals act according to real and perceived benefits and costs of continuing a relationship (Frude, 1990). The most dependent is the least powerful. However, the least powerless may also seek to maximise gains and minimise contributions to be made to a relationship. The person cared for may be seen as an inconvenience and a subculture of abuse may arise in formal care-giving situations (see also Aitken and Griffin, 1996).

 

Jack (1994) uses Seligman's (1975) work on 'learned helplessness' to show that ageist stereotypes of dependence and increasing incompetence lead to the erosion of personal control in the context of formal care. Perceived powerlessness and dependency has been implicated in abusers in formal and informal settings.

 

Women carers predominate in the workforce and the work is subsequently devalued. Women who are cared for are also discriminated against. Jack (1994, p.89) states:

 

'...in order to ensure her dependency-needs are met, the old woman is compelled to surrender her claim to adult status to the female carer, whose limited status within the organisation depends on her complete possession of the caring role.'

 

The search for pathology has neglected formal carers and offered little in the way of theoretical understanding.

 

'...powerlessness among carers and cared for is the lock confining them within a relationship of dependency and violation...their mutual empowerment is the key to interdependency without subordination.' (Jack, 1994, p. 90)

 

It is possible that the Foucauldian metaphor of the 'panopticon' may be useful in connection with such considerations (Foucault, 1979). The panopticon was taken from an idea for prison design originated by Jeremy Bentham. All levels of the prison could be seen at all times and prisoners would not know whether or not they were being watched at any given time. Foucault suggests that social surveillance techniques operate in a similar way.

 

Such a perspective would also suggest that surveillance of social and health care agencies and institutions has developed in recent years. The recent development in the UK of continual assessment for service users and for staff development may engender feelings for both older recipients of care and of formal care staff of continued surveillance, of not being able to escape or resist effectively.

 

This would therefore set the scene for the creation and maintenance of dependence and marginalisation by encouraging learned helplessness and submission to the power of surveillance. Disciplinary practices in use within health and social care agencies contribute to the operation of power through techniques of visibility. Additionally, designs aimed at maximum surveillance are used, and the processing, filing, creation and maintenance of individual cases perpetuates the situation. Divisions are created by binary distinctions such as practitioner and client, old and young, healthy and unhealthy, abuser and abused, male and female and the subject begins to watch over and monitor the self (Fawcett, 1996).

 

In the contemporary arena of social and health care, numerous strategies have been developed to regulate the imposition of power. These include judicial review, the development of law centres and advice bureaux (Trotter, 1999). Competition and inspection in public sector services has demanded a shift from casework to practice that is measurable and verifiable. This kind of regulation sets up its own discourse and is, itself, a form of power.

 

Control over resources is an important dynamic of power when considering the allocation of social and health care. Service users are often faced with stark perceived choices when the practitioner or agency is assumed able to offer and withdraw services at will. The potential of the institution and agency to abuse directly and the replication of an abusive system are now being given serious consideration (Goffman, 1968; Stanley, Manthorpe and Penhale, 1999).

 

Multiple forms of disadvantage

Recent perspectives explicitly incorporate the role of gender, race and class in influencing power dynamics. Ragin and Sunstrom (1989) suggest that sex-role socialisation leads to the adoption and expectation of stereotypical roles, which lead women to be perceived as lacking in power at organisational, sociocultural and interpersonal levels. Rosspenda, Richman, and Nawyn (1998) add race and class issues to gender in traditional models of sexual harassment as a consequence of power differentials based on location or status differences between men and women. Their research found the confluence of race, class and gender to be especially important where the target of the harassment has greater organisational power than the perpetrator.

 

Kukli and Breli (1997) employ a social exchange theory perspective to make the valuable point that prospective dependency may change marital power relationships in later life. Askham (1995) suggests, however, that gender-power differences continue in later life marriages. These analyses are much akin to Thompson's (1997, 1998) Personal, Cultural and Structural (PCS) model for theorising discrimination and oppression. The influences of personal prejudice with organisational culture and social structures are linked together by Thompson in a complex and continually changing way, resulting, he suggests, in oppressive practices.

 

Power is, of course, central to issues of gender. Mullender (1997) states that it is impossible to understand the personal and social world without taking a gendered perspective. Gender represents a social construction (Berger and Luckman, 1966). That is, gender relates to the roles, tasks, positions and assumptions associated with male and female within a particular social context. These roles and assumptions are internalised by those brought up within that society. Acting according to the ways a society prescribes inhibits resistance to oppression and recreates the social construction of gender.

 

Sexism does not refer solely to the prejudice expressed by individual males. It results also from the social structures developed to perpetuate a gendered ordering of society and the ways in which agencies and organisations reflect this order and instil normative roles and expectations into members. Sexism and the unequal distribution of power and roles in society can be linked with other forms of oppression leading to the necessity of a gender power analysis, which places gender within a wider socio-political context. For instance, child care is seen as the role of women as are care in the community and low paid care jobs in residential homes.

 

It is not only race, class and gender that interact, however. The social construction of ageing as negative and stigmatising is important (Bytheway, 1994). Aitken and Griffin (1996) remind us that there are proportionately more women than men in the general population the older that population becomes. Older women are marginalised in society on the grounds of gender and age. The negative connotations of ageism and ideas of dependency and impairment aggregate in the negotiations of power within society. Ageism, sexism and structural divisions combine to create power imbalances that are predicated on the notion of women as of inferior status. This facilitates the conditions in which abuse flourishes and militates against easy or quick resolution.

 

Ageism may be of further importance within such considerations as a ‘master’ category (Bytheway, 1994). Such multiple forms of disadvantage are of significance too, since they may not assist in any movement towards resolution of the problem, or, indeed, prevention.  In addition, we can see that older women may face several distinct but overlapping areas of risk and disadvantage, perhaps even of jeopardy (Penhale and Kingston, 1995) and that these may be either singular or cumulative in their effect.

 

Towards a gendered analysis

Feminist theories of elder abuse move beyond the health and welfare debates to a theory in which age and gender and the relationships between them and other social divisions are given equal importance. The potential for violence and abuse is fundamental to gender and power in all social relationships.

 

'A feminist analysis of elder abuse, whilst recognising the gendered nature of inequality, would have to acknowledge women's capacity for violence and recognise that the issue of power is more problematic and less fixed than previously imagined. The connections between relations of age, gender and power would be central categories of analysis and the notion of power would require a different treatment.

 

'This means treating power like age and gender relations as something fluid, rather than fixed and monolithic, as something which varies according to what it is in relation to or with.' (Whittaker, 1996, p. 152)

 

There is generally a lack of such a feminist critique of elder abuse although gender relations have been seen as central to examinations of child physical abuse (Featherstone, 1997). The concept of domination rather than power has been employed to demonstrate its significance. Research concerning domestic violence and the development of interagency working places necessary emphasis on domestic violence towards adult women and children. Older women are generally not included within such considerations, although the research does not explicitly exclude them (Hague and Malos, 1998). There is, however, a marginalisation of older people and an uncritical reinforcement of hierarchies of concern that reflects sociocultural power relations. Whittaker (1996) advocates a methodology of inclusion in participative research about elder abuse, which, she states, cannot be divorced from its social context and the patriarchal rather than pathological family. It is crucial, of course, that older people themselves are fully included as central actors within such developments.

 

Feminist analyses start with gender. The marginalisation of older people and, in particular, older women in society is taken into account. The patriarchal context sees men as having access to greater power over the more vulnerable and less powerful and being protected by societal norms. Whittaker (1996) therefore reframes the allegedly controlling characteristics and behaviours of non-compliant dependent victims as a struggle and resistance against oppression and male control. This moves away from explanations based on caregiver stress that have developed within the field of elder abuse and neglect and that absolve the perpetrator of responsibility.

 

Gelles (1993) suggests that feminist theory presents an analysis of only one type of violence and victimisation. It does not, in his view, account for child abuse, sibling abuse, violence by women or the abuse of older people. Featherstone (1997) disagrees with Gelles' analysis and suggests that in fact great differences and divergences now characterise feminisms. What the critiques by Gelles and Straus appear to fail to take into account are considerations of the interactions between different factors within feminist analyses.

 

When gender is seen as a constructed sociocultural process rather than biologically determined as 'sex', it is no longer enough to consider that males are violent, and women are peaceful and nurturing. Appropriate use of the former approach highlights diversity and rejects the attempt to define one sole cause of women's oppression.

 

Featherstone (1997, p. 431) argues for:

 

'...an engagement with some of the perspectives... characterized by an appreciation that gendered positions are significant explanatory tools in exploring violence but that these positions are neither fixed nor inevitable. They are subject to constant struggle and redefinition.'

 

At first sight, it may seem obvious and uncontroversial that gender and power issues are central to elder abuse. However, they relate and interrelate in extremely complex ways. For instance, we cannot blame one single aspect of gender or power relations for the development of violence and aggression between humans. It is not enough to say that elder abuse is perpetrated by damaged, sick or stressed individuals – namely men -or that attitudes that allow the continuation of elder abuse simply result from personal prejudice. We must now consider the complex interplay of structural power relations throughout society as setting the context for abuse to be minimised condoned, exacerbated or even perpetrated.

 

However, this wider social explanation is also, in itself, insufficient. It is necessary to examine the organisational, agency and cultural factors reflecting the social structures, which encourage maintenance of the status quo in respect of gender divided roles, work and status. The socialisation of individuals in families is created by the wider social structures and cultural factors and, in turn, recreates them by subscribing to the gender and power games advanced. All these interact to produce individual experiences and behaviours some of which are fundamentally abusive and proscribed by society, some of which are neither condoned nor proscribed and some of which are perpetuated within the existing social fabric. This is often internalised by individuals who then add to the maintenance and development of a gendered and unequal society.

 

It is the social organisation of gender that allocates roles and meaning and which contributes to the marginalisation of elder abuse at a social, agency and personal level. As Thompson (1997) states in respect of anti-discriminatory practice, those who are not actively seeking to change this state of affairs are part of the problem. It is the responsibility of us all, therefore, as practitioners or simply as citizens, to acknowledge our own assumptions and gendered positions. We must work with agencies and organisations and the wider society to develop an approach that recognises the importance of gender and power relations and seek to influence those who set the terms of the argument at policy-making and political levels. As Kaufman (1994, p. 146) indicated, 'we all experience power in diverse ways, some that celebrate life and diversity and others that hinge on control and domination'. A gender-power analysis can be usefully employed to develop approaches that celebrate life and diversity in our attempts to deal with elder abuse.

 

Bibliography

 

Aitken, L. and Griffin, G. (1996) Gender and Elder Abuse, London: Sage.

 

Arber, S. and Ginn, J. (1995) (Eds.) Connecting gender and ageing: sociological approaches to gender relations in later life, Buckingham: Open University Press.

 

Askham, J. (1995) “The married lives of older people”, in Arber, S. and Ginn, J. (Eds.) Connecting Gender and Ageing. A sociological approach to gender relations in later life, Buckingham: Open University Press.

 

Baker, A. A. (1977) “Granny battering”, Modern Geriatrics, 5, (8): 20-4

 

Barnett, O., Miller-Perrin, C. and Perrin, R. (1997) Family Violence across the Lifespan. An Introduction. Thousand Oaks, Ca: Sage.

 

Bennett, G. and Kingston, P. (1993) Elder Abuse: Theories, Concepts and Interventions, London: Chapman and Hall.

 

Bennett, G., Kingston, P. and Penhale, B. (1997) The Dimensions of elder abuse: Perspectives for the practitioner. Basingstoke: Macmillan.

 

Berger, P. and Luckman, T. (1966) The Social Construction of Reality, London: Allen Lane.

 

Biggs, S.; Phillipson, C. and Kingston, P. (1995) Elder Abuse in Perspective, Buckingham: Open University.

 

Bytheway, B. (1994) Ageism, Buckingham: Open University Press.

 

Fawcett, B. (1996) “Women, mental health and community care: an abusive combination?” in Fawcett, B., Featherstone, B., Hearn, J. and Toft, C. (Eds.) Violence and Gender Relations. Theories and Interventions, London: Sage.

 

Featherstone, B. (1997) “What has gender got to do with it? Exploring physically abusive behaviour towards children”, British Journal of Social Work, 27, 3, pp. 419-33.

 

Foucault, M. (1977) Discipline and Punishment: the birth of the prison London: Tavistock.

 

Frude, N. (1990) Understanding Family Problems: a psychological approach, Chichester: John Wiley and Sons.

 

Gelles, R. (1993) “Through a sociological lens: social structure and family violence”, in Gelles, R. and Loseke, D. (Eds.) Current Controversies on Family Violence, London: Sage.

 

Gelles, R. and Straus, M. (1979) “Violence in the American family” Journal of Social Issues, 35 (2): 15-39.

 

Glendenning, F. and Kingston, P. (1999) Elder Abuse and Neglect in Residential Settings: different national backgrounds and similar responses, New York: Haworth Maltreatment and Trauma Press.

 

Goffman, E. (1961) Asylums: essays on the social situation of mental patients and other inmates, Reading: Penguin.

 

Grafstrom, M., Norberg, A. and Wimblad, B. (1992) “Abuse is in the eye of the beholder. Reports by family members about abuse of demented persons in home care. A total population based study”, Scandinavian Journal of Social Medicine. 24, 4: 247-55.

 

Hague, G. and Malos, E. (1998) “Interagency approaches to domestic violence and the role of social services”, British Journal of Social Work, 28, 3: 369-86.

 

Halicka, M. (1995) “Elder abuse and neglect in Poland”, Journal of Elder Abuse and Neglect. 6: 157-69.

 

Hamner, J. and Hearn, J. (1999) “Gender and Welfare research” in Williams, F., Popay, J. and Oakley, A. (Eds.) Welfare research: A critical review London: UCL Press.

 

Hughes, B, (1995) Older people and community care, Buckingham: Open University Press.

 

Illich, I.; Zola, I. K.; McKnight, J.; Caplan, J. and Shaiken, H. (1974) Disabling Professions, London: Marion Boyars.

 

Jack, R. (1994) “Dependence, power and violation; gender issues in the abuse of elderly people by formal carers” in Eastman, M. (1994) (Ed.) Old Age Abuse, London: Chapman Hall.

 

Johns, S., and Hydle, I. (1995) “Norway: Weakness in Welfare” Journal of Elder Abuse and Neglect. 6, 3-4, 139-156.

 

Kaufman, M. (1994) “Men, feminism, and men's contradictory experiences of power”, in Brod, H. and Kaufman, M. (Eds.) Theorizing Masculinities, Thousand Oaks, CA.: Sage.

 

Kosberg, J. (1998) “Abuse of Elderly Men” Journal of Elder Abuse and Neglect. 9, 3, 69-88.

 

Kulik, L. and Breli, H. (1997) “Continuity and discontinuity in attitudes towards marital power relations: pre-retired vs. retired husbands”, Ageing and Society, 17, 5, p. 571-95.

 

McCreadie, C. (1992) Elder abuse: an exploratory study, London; HMSO

 

McCreadie, C. (1996) Elder abuse: an Update on research, London: HMSO.

 

McCreadie, C. and Quigley, L. (1999) “Figuring out Adult Abuse”, Community Care, 1258, 4-10 February, 24-25.

 

Miller, R. B. and Dodder, R. A. (1989) "The Abused: Abuser Dyad; Elder Abuse in the State of Florida" in Filinson, R. and Ingman, S. R. (Eds.) (1989) Elder Abuse: Practice and Policy, New York: Human Sciences Press.

 

Mullender, A. (1997) Rethinking Domestic Violence: the social work and probation response, London: Routledge.

 

Penhale, B. (1993) "The Abuse of Elderly People: Considerations for Practice", British Journal of Social Work, 23, 2, 95-112.

 

Penhale, B. and Kingston, P. (1995) “Social Perspectives and elder abuse” in Kingston, P. and Penhale, B. (1995) (Eds.) Family Violence and the Caring Professions, Basingstoke: Macmillan.

 

Parker, J. and Penhale, B. (1998) Protecting People, London: OLF/BASW.

 

Pillemer, K. A. (1986) "Risk factors in elder abuse: Results from a case-control study" in Pillemer, K. A. and Wolf, R. S. (Eds.) (1986) Elder Abuse: conflict in the family, Dover, Massachusetts: Auburn House.

 

Pillemer, K. A. and Wolf, R. S. (Eds.) (1986) Elder Abuse: conflict in the family, Dover, Massachusetts, Auburn House.

 

Pillemer, K. A. and Finkelhor, D. (1988) "The prevalence of elder abuse: A random sample survey," Gerontologist, 28 (1): 51-57.

 

Pillemer, K. A. and Suitor, J. J. (1992) “Violence and violent feelings. What causes them among family caregivers?” Journal of Gerontology: Social Sciences. 4, 7: S165-72.

 

Ragin, B. and Sunstrom, E. (1989) “Gender and power in organisations: a longitudinal perspective”, Psychological Bulletin, 105, pp. 51-88

 

Rosspenda, K. M., Richman, J. A. and Nawyn, S. J. (1998) “Doing power: the confluence of gender, race, and class in contrapower harassment”, Gender and Society, 12, 1, pp. 40-60.

 

Scheff, T. (1974) “The Labelling Theory of Mental Illness”, American Sociological Review 39, (June), 444-452.

 

Seligman, M. (1975) Helplessness, San Francisco, Ca: W.H. Freeman.

 

Stanley, N.; Manthorpe, J. and Penhale, B. (1999) (Eds.) Institutional abuse: perspectives across the lifecourse, London: Routledge.

 

Stevenson, O. and Parsloe, P. (1993) Community care and empowerment, York: Joseph Rowntree Foundation.

 

Straus, M. (1993) “Physical assaults by wives – a major social problem”, in R. Gelles, R. and Loseke, D. (Eds.) Current Controversies on Family Violence. Newbury Park, Ca: Sage.

 

Tatara, T. (1993) “Finding the nature and scope of domestic elder abuse with state aggregate data”, Journal of Elder Abuse and Neglect, 5 (4): 35-6.

 

Thompson, N. (1997) Anti-discriminatory Practice, (2nd ed.) Basingstoke: Macmillan.

 

Thompson, N. (1998) Promoting Equality, Basingstoke: Macmillan.

 

Trotter, C. (1999) Working with Involuntary Clients, London: Sage.

 

Whittaker, T. (1995) “Gender and elder abuse”, in Arber, S. and Ginn, J. (1995) (Eds.) Connecting gender and ageing: sociological approaches to gender relations in later life, Buckingham, Open University Press.

 

Whittaker, T. (1996) “Elder abuse”, in Fawcett, B., Featherstone, B., Hearn, J. and Toft, C. (Eds.) Violence and Gender Relations. Theories and Interventions, London: Sage.

 

Wolf, R. (1994) “Responding to Elder Abuse in the USA” in Action on Elder Abuse Working Paper No.1: A report on the proceedings of the 1st International Symposium on Elder Abuse, London: Action on Elder Abuse.

 

Yllo, K. (1993) “Through a feminist lens: gender, power and violence” in Gelles, R. and Loseke, D. (1993) (Eds.) Current Controversies in Family Violence, Newbury Park, Ca: Sage.

 


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