Older Brazilian women’s experience of psychological domestic violence: a social phenomenological study

Violence against older adults is a complex and multidimensional problem that impacts on social, psychological and physical dimensions, affecting the public heath and the human rights [1]. According to the International Network for the Prevention of Elder Abuse (INPEA), violence against older adults is defined as: “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person” [2].

The World Health Organization (WHO) states that the prevalence of violence experienced by the elderly ranges from 1% to 35% [3]. In Brazil, two studies [4, 5] have analysed the prevalence of physical violence against older men and women in small towns: Camaragibe, Pernambuco [6] with 144,466 inhabitants [4]; and Niterói, Rio de Janeiro [7] with a population of 487,562 [4]. These studies (with sample sizes of 315 and 343 subjects respectively) reported that the prevalence of physical domestic violence against older adults was about 10% [6–7]. This results indicate that the prevalence found in these Brazilian studies is high when compared with 2.2% in Ireland [8] and 2.6% in United Kingdom [9]. On other hand, the findings of Brazilian studies is close to those found in Canada, which range between 4% and 10% [2], in Spain (11.9%) [9], and in Portugal (12.3%) [10]. However, they are low when compared with 18.4% in Israel, with 21.4% in Hong Kong [9] and a range from 13.9% to 25.8% in Chinese older adults living in the Greater Chicago area [11].

Among the subtypes of violence against older adults, psychological abuse is one of the most prevalent [12]. Results of a study on psychological abuse among older women conducted in the United States of America indicate a prevalence of 45%. Among those who have suffered psychological abuse, 48% reported two or more abusive actions, such as: abusive language, overly critical, screaming, possessive behaviour or jealousy signs. Furthermore, among older women experiencing different subtypes of violence, researchers found a range of 86% and 95% suffering psychological abuse [12]. Among Portuguese people, the prevalence of psychological abuse was 6.3%, the same as financial (6.3%). Other types of violence included: Physical abuse (2.3%), neglect (0.4%), and sexual abuse (0.2%) [10]. The prevalence of psychological abuse among Chinese older adults living in the Greater area of Chicago was 1.1%-9.8%, physical abuse was 1.1%, sexual abuse was 0.2%, caregiver neglect was 4.6%-11.1%, and financial exploitation was 8.8%-9.3% [11].

The psychological abuse may occur in isolation or in combination with other kinds of abuse [12]. However, many older adults do not consider it as a type of domestic violence [13]. In addiction, psychological abuse tends to receive little attention from researchers [14].

Psychological abuse of older adults refers to “a verbal or gestural action whose aim is to terrorize, to humiliate, to restrict freedom, or to isolate older adults from society” [15]. This subtype of abuse can bring negative consequences to the victims’ life and health, what includes decreased sense of power, shame, fear of retaliation, fear of institutionalization, isolation, anxiety, depressive symptoms and changes in health status [14].

The other types of abuse are defined as: physical abuse, financial/material abuse, sexual abuse, and neglect. First is defined as the infliction of pain or injury, physical coercion, or physical/chemical restraint. Second is described as the illegal or improper exploitation and/or use of funds or resources. Third corresponds to a non-consensual contact of any kind with an older person and fourth is the intentional or unintentional refusal or failure to fulfil a care-taking obligation’ [2,3].

Both men and women can be categorized as either perpetrators or victims of domestic violence. However, more than 70% of the victims of all types of violence are women [16]. In surveys, women who reported experiencing psychological violence also reported a lower quality of health than those experiencing physical violence [14].

INPEA highlighted that whereas one in four older adults are at risk of domestic violence, only a small proportion of domestic violence against older adults is actually reported [2]. Underreporting may be due to: victims hesitating to admit they are being victimized, religious and cultural beliefs, social norms, fear of reprisal, protection provided for the abuser, shame, guilt, helplessness, and despair [17]. In Brazil, the report of abuse of older adults is mandatory for health professionals such as nurses, physicians, dentists, and psychologists [18]. However, a study found that 60% of doctors and nurses in Brazil have not received any formal education about domestic violence and, consequently, they feel unprepared to provide appropriate care and referral [19]. The most cases of domestic violence against older adults in Brazil are only reported when they result in physical injuries [20].

Brazil currently has 23.5 million people over 60 years old, representing 12.1% of the total population from which 13.1 million (55.70%) are women [4]. The number o folder adults expected in 2025 is approximately 30 million, what is equivalent to 15% of the population [5]. Analysing social and economic aspects of the Brazilian population, we can state that illiteracy decreased, from 11.5% in 2004 to 8.3% in 2013; and schooling increased from 78.1% in 2012 to 81.2% in 2013. Regarding to the poverty, about one million people left misery in 2012 and the income inequity lowered by 54.9% from 2002 to 2012. However, in Brazil, there still are 15.7 million people living in poverty and a high level of social inequity [4]. This context stems from the relationship of command/subservience among poor people and the owners of farms, a structure that formed the basis of the Brazilian culture, even after the abolishment of slavery.

Moreover, Brazilian culture is marked by traditional gender values and patriarchy, in which the male is defined as the subject of sexuality and the female as its object [21]. Brazilians have often considered themselves as a nonracist society due to the historical blending of indigenous American, Iberian, and African peoples into a single national identity. However, ‘race’ in Brazil is embodied in everyday valuations of sexual attractiveness that are gender, race, and class-oriented. Ageism in Brazil should be addressed in the context of multiple discriminations [22].

In response to the international movement for adopting specific measures to protect older adults, the Brazilian National Elderly Policy was published in 1994 [23]. The Senior Citizens’ Statute was published in 2003 [24], and the National Elderly Health Policy was published in 2006 [25]. These policies and documents have helped improve legal protections for older adults and have strengthened legal guidelines to address violent situations among this population. Despite such programs, statistical trends of psychological domestic violence against older people in Brazil are still not known.

There is also a lack of qualitative research focused on psychological domestic violence from the older women’s point of view. Therefore, the aim of this study is to understand older adult women’s experience of psychological domestic violence. The primary research question for this study was: What are older Brazilian women’s experiences of psychological domestic violence? The related questions were: 1) How older Brazilian women experience their daily life when they are victims of psychological domestic violence? 2) How do older Brazilian women respond to psychological domestic violence? and 3) What are older Brazilian women’s needs, expectations, and aims in dealing with the psychological domestic violence in their lives?

A qualitative study was conducted using a social phenomenological approach that was designed to help clarify the social relations underlying the domestic violence [26]. In particular, we applied Alfred Schutz’s work [27], which allows the investigation of individual behaviour, and the understanding of the experiences lived by a social group in a specific situation. We explored the Schutz’s key concepts that are related to older adult women subjected to psychological violence. We used his concepts throughout the paper as our lens for data analysis and reporting. These concepts were: the world of everyday life, natural attitudes, intersubjectivity, stock of knowledge, biographical situation, social action, motivation (reason why and reason for), and typification [27]. According to Schutz, interpreting human action requires identifying individuals’ ‘world of everyday life’ [28]. Within the ‘world of everyday life’, people act in a natural way, based on what is presented to them as a social reality. The ability to intervene in this world, influencing and being influenced, is called ‘natural attitude’ [28]. ‘Intersubjectivity’ is a precondition of social life: the source of meanings. Experiences are highly individualized and stem from the meanings that each individual attaches through consciousness. So, the experiences of the phenomenon become visible through individuals reflection. Her/his own interests, motives, desires, and ideological and religious commitments shape these interpretations, and her/his experiences bring a ‘stock of knowledge’ that is available according to the ‘biographical situation’ of each person. Therefore, the individual’s choice for an action is always related to other actions, to the current context, and to the future behaviours. Whether manifest or latent, the chosen action becomes a social reality and presupposes a typification, what means that an individual will act typically the same way in a similar situation. Individuals choose an action based on their motives/motivations: ‘reasons why’ and ‘reasons for’ [27]. A ‘reason why’ is related to past experiences and is an objective category accessible for a researcher. A ‘reason for,’ which guides future actions, is subjective. Researchers may capture an individual’s experience through the identification of his/her ‘reason for’ (an anticipated or imagined action) in relation to the experienced situation. Schutz’s theory was applied throughout the research process to ensure the methodology consistency [29].

The research ethics board at the University of São Paulo, and the three agencies granted approval for the study. Following this, participants were informed about the study and received the written consent forms. The signature of these forms was required to ensure the participation of individuals in the study. The information included the study objectives, the use of the audio-recorder, and how confidentiality would be ensured. Participants were advised that they were free to choose whether or not to participate in the study, that they could withdraw from the study anytime without any impact on their access to services, and that the collected data would be only used for the purpose of the study.

Confidentiality was maintained by: assigning all participants coded numbers to ensure data were anonymous; storing consent forms and identifiers in a locked cabinet (at the School of Nursing at the University of São Paulo); storing interview tapes in a separate locked cabinet (also at the School of Nursing); protecting all electronic information with an encrypted password; not sending any data by mail; and ensuring that leaders at each agency remained unaware of participants’ decisions to participate or not. None of the identifiers or raw data were available to anyone outside the research team. We destroyed interview tapes after the content were transcribed and checked for accuracy, and the transcripts will be destroyed five years after the completion of the study.

The findings are showed into two themes: ‘context of the violence’ and ‘expectations of the older women’. First category emerged from the participants’ ‘reason why’ and second one emerged from the participants’ ‘reason for’.

Interviews revealed the relationships among older women participants and their abusers during everyday life. These relationships were shaped by manifestations of violence such as verbal abuse, abusive gestures, threats, humiliation, disrespect, control, neglect, and exploitation. This violence generated feelings of sadness, anger, fear, hurt, and suffering. These abusive acts and behaviours represent some of the examples identified by Bavel [1] that included teasing, verbal degradation, threats, humiliation, coercion, intimidation, disenfranchisement, name calling, accusations, general disrespect, yelling, blaming, criticising, and offensive comments, among others. Also, these manifestations limited the older women’s ability to make decisions, and reduced their confidence and self-esteem.

Our participants also referred a lack of freedom. Bavel [1] identified various actions that family members undertake to isolate older people from society, such as: leaving them alone at home, not letting them use the phone, and controlling their lives. Strong evidence indicates that social isolation and a lack of social relations contribute to violence against older people who are already being victimized [30]. Failure to provide adequate food, clothes, shelter, medical care, and hygiene are examples of neglect acts [3].

Another manifestation of violence was psychological pressure, which some participants referred as ‘mental torture.’ This psychological pressure can also result from other forms of violence, such as financial, physical, verbal, or from neglect [31]. Our analyses revealed that psychological and financial abuse occurred concomitantly, fact that was mentioned in almost all of the interviews. Financial victimization is usually connected to other forms of violence. The abuser is usually a family member and the victims may fail to realize that financial abuse is a form of violence that should be reported [32]. This kind of abuse includes exploitation and/or use of funds or resources that belong to the older person [3].

Finally, analyses revealed the presence of ageism, the stereotypical and often negative bias involving age groups, and in particular older adults. Ageism, as any kind of discrimination, can essentially be thought as the applying of collective age-based characteristics to an individual, regardless of their individual features [33]. The older women and their abusers experience the interpersonal communication and the intersubjectivity, influencing and being influenced, understanding and being understood, acting and reacting upon each other [28]. Family members acted violently against the older women who responded through several strategies that frequently were unsuccessful. Both actions and reactions of the violence were influenced by the situational context experienced for the participants. Perceptions of violence and how violence manifests are influenced for each individual’s ‘stock of knowledge’, which is related to her/his ‘biographical situation’ and to ‘natural attitude of the world of everyday life’ [28]. In other words, the victims’ stock of knowledge influenced their own actions.

The participants’ daily lives involved diverse and ambivalent feelings. They felt sad, angry, afraid, and not at peace. Simultaneously, the participants love their family members, feel compassion, try to protect the aggressor and justify their violent actions. A study conducted in Ireland reported that participants feel a natural parental instinct to protect their children and to maintain the belief that they are good people, no matter what they do. This study also found that a situation considered abusive by the societies may be considered ‘normal’ within a family core [31]. Schutz described this parental instinct as a ‘natural attitude’ [28] and he defined the set of reasons for a social action as the intentionality of a person toward the accomplishment of a purpose [27]. Analyses of the experience of psychological violence lived by the older women in the study revealed ‘reasons why’, such as: the manifestation of violence, feelings (psychological reactions) and health- related consequences, compassion for the aggressor, need for support, limited availability of choices, and powerlessness. ‘Reasons for’ (i.e., guiding their future actions) included changing the aggressor’s behaviour or leaving the situation.

The interviews revealed that exposure to psychological violence affected participants’ physical and mental health. This concurred with a previous study that reported that older women suffer physically after experiencing years of violence [34].

The participants expressed the need to get help from someone, or to identify someone who might support them in the future. However, according to O’Brien et al. (2011), participants believed that older people do not appreciate a neighbour’s intervention in the their personal life, and they also felt inappropriate to involve external agencies such as the police or social services in household matters [31].

One effective way to address cases of domestic violence involves specialized services comprised by various professionals who are trained to help older people experiencing domestic violence. Nurses have been increasingly seen as effective professionals in the fields of individual and collective care related to violence, and forensic nurses may work in primary, secondary, and tertiary care [35]. In this sense, few services have been organized in Brazil to identify and report violence against older adults. The complexity of this issue requires various actions to deal with the many demands involved in these types of abusive situations [36].

The study participants had tried to face their violent situations, but felt powerless due to their limited support network, and they generally did not seek external help (e.g., police or social workers). Other research has also revealed that older adults who experience violence usually stay quiet due to the fear of reprisal, to the misinformation about their rights, or to the lack of appropriate support [36].

The research findings in this study are useful for health care professionals. Victimized older women may ignore their own safety in order to protect the aggressor abuser, and they often tend to desire for changing the abuser’s behaviour. Highlighting this finding is relevant because Brazil has no programs focused on aggressors rehabilitating. The legal system addresses violence by arresting the abusive family member, which may be against the victim’s will. The research findings indicate that having the violent abuser arrested is not an option for many older women, so it may be helpful to develop strategies focused on the abuser’s rehabilitation. If our participants had more resources and information about domestic violence, they may have different expectations about their situations. One efficient form of emotional support might be to create group activities related to this topic at various community centres/agencies, where the victims could share their experiences and develop strategies to deal with the violence together with other people.

Future research might help to clarify the context of violence from the perspective of the abusive family member; to identify educational intervention for abusers; and to work with nurses in practice settings to evaluate the effectiveness of education and other interventions targeting abusers. Other priorities also include developing support services for victims of violence (such as shelters), creating educational programs for abuser, providing legal, social, and health information about resources to address violence against older women, as well as providing social, financial, and emotional support to the victims of elder abuse or referring them to other professionals/institutions who/that provide such services.