When she was 18, Elisabeth Fritzl's father Josef locked her away in a tiny basement space beneath a house, according to investigators in the small Austrian town of Amstetten.
During her captivity, she endured far more than isolation. In the 24 years that passed before she was found again, she was repeatedly raped by her father — and gave birth to seven children as a result, authorities said.
Some of these children were sent away. Others were allegedly forced to stay underground, never to see the light of day.
Now, according to officials with the Lower Austrian Bureau of Criminal Affairs, Fritzl and her children are receiving psychiatric care. But psychological experts say that even with the best help and counseling, the woman and three of her children, who were imprisoned with her, face unimaginable hurdles in coping with their experience.
"The situation for these women and children is so extraordinarily grotesque that the only [thing] comparable I can think of are children who spent their childhood years in a death camp or concentration camp or in the Cambodian killing fields," said Rona M. Fields, a psychologist and national spokesperson for the Children's Rights Council, who has experience treating children who have survived such traumatic situations.
"Elisabeth and her children will need years of intensive psychotherapy to start to heal these wounds," said Beverly Hills psychiatrist and author Dr. Carole Lieberman. "They will be overwhelmed by feelings of shame, rage, depression, confusion, lack of identity, and so on."
The horrific nature of the story has sent the country into shock, with the Austrian interior minister calling it "unfathomable."
Three of the children shared their mother's plight from birth. They shared the small cellar space with her and were not allowed to leave, authorities said.
Three others were allegedly raised by Elisabeth's parents, never having knowledge of their mother's situation.
And Elisabeth told investigators that one of the children died several days after its birth in 1996. This infant's body, she said, was taken by her father and burned in the furnace.
For both Elisabeth and her children, the trauma of these events could make it difficult for them to start the healing process.
"Treatment and recovery cannot begin until she and her children feel safe and there is no more threat of danger," said Ginny Sprang, director of the Center for the Study of Violence Against Children, at the University of Kentucky in Lexington. "This would include exposure to triggers, such as contact with her father, the criminal prosecution, reliving the event through testimony."
Nadine Kaslow, chief psychologist at Grady Memorial Hospital in Atlanta and a professor at Emory University's School of Medicine, agreed.
"It will be extremely difficult for the woman and her children to cope with the memories, and it is likely that they will each do so differently and in different time frames," Kaslow said. "Some may want to talk about them and others may not.
"The mother is most likely to blame herself and not be able to trust men. The children will have missed out on important developmental experiences — friends, school, activities. ... They will need help in slowly participating in each of these experiences."
And the trauma of the past two decades may also have a profound impact on the relationship that Elisabeth has with her children.
"Since she has never had any frame of reference, I assume, for a healthy parent-child relationship — a key ingredient in promoting adaptive functioning in children — it is possible that her relationships with her own children are strained, ambivalent or avoidant," Sprang said. "This will pose unique challenges to her children."
Still, the relationship that the children have with their mother may be their strongest tether to normal human interaction. This relationship will be tremendously important, as the children will likely face a number of psychiatric issues stemming from their captivity.
"For the kids born and raised in captivity, they are likely to think that what they lived and experienced was normal, since that is all they know," said Dr. Vatsal Thakkar, clinical assistant professor of psychiatry at the New York University School of Medicine. "It is entirely possible that they may have a sharply limited capacity to ever attain a normal life in a world that is foreign to them."
"Schizophrenia is a likely outcome, and PTSD [post-traumatic stress disorder] is a minimal prospect," Fields said.
But she added that recovery — and a semblance of a normal life — may not be completely out of the question.
"Some of the children born in death camps, and with their earliest experiences only in these horrors, have grown up and — despite periodic episodic reaction breakdowns — managed to form relationships and live somewhat normal lives with the help of continuing therapy and support," Fields said.
And the road to this recovery could begin with compassion and support.
"You begin with kindness and love," said Roberta Temes, a psychiatrist at Downstate Medical School in Brooklyn, N.Y.
"Memories will not make themselves known until the woman and her children are psychologically strong enough to cope with those memories," she said. "Until then, if they stay away from energetic shrinks, they should be able to build up their psychological resources and gradually assimilate into society.
"The children, with enough opportunities to play, might surprise us and be just fine."