Can Austria's Cellar Children Recover?

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View of the back of Josef Fritzl's house

It is hard to imagine more ill-fated births than those of Kerstin, Stefan and Felix Fritzl. In 1984, their father, Josef, the authoritarian patriarch of an already sprawling Austrian family, locked his teenage daughter Elisabeth into a converted nuclear shelter underneath his house in the town of Amstetten so he could rape her at will. His incestuous abuse led to the birth of seven children, three of whom he kept imprisoned underground with their mother. Until April 26, when Austrian authorities discovered Fritzl's lair, reality for those children stretched no further than their dank, windowless confines, their mother's memories of the outside, and a television set.

From this subterranean realm, Felix, 5, Stefan, 18, and Kerstin, 19, have now come blinking into the world. While Austria recoils in horror at the crime that produced the children, and grapples with how it remained undiscovered for so long, the Fritzls have a more basic challenge ahead of them: survival. Can children constrained to such a stunted sphere adjust to the world's cacophony? And what can modern science and medicine do to help?

The condition of the oldest child, Kerstin, demonstrates the physical insults of a life so confined. Ravaged by an unidentified infection, she is currently in a medically induced coma. There have been reports that, despite her youth, many of her teeth are missing. Stefan has fared somewhat better, although his skin, like that of his siblings, is ghostly pale. Life in a warren of narrow corridors and low ceilings has damaged the spatial orientation of Stefan and Felix, and there may be more serious consequences for all three: health experts say a chronic lack of sunlight and exercise can leave children's bones pliable, their muscles weak and their eyes overly sensitive to strong light.

The Fritzls' vulnerabilities hardly stop there. The immune system, like the brain, requires stimulation to develop. Carol Baker, an infectious-disease specialist at the U.S. Centers for Disease Control and Prevention, says even a bout of the flu could prove serious as the Fritzls may never have encountered the virus that causes it. Baker says their health depends now on prompt vaccinations and careful monitoring. If treated properly, she adds, "biologically, they can be restored."

On Thursday, the Austrian publication News Magazin published comments from the incarcerated Josef Fritzl conveyed by his lawyer. Fritzl declared he was a good father, bringing gifts to his children in what he called "the bunker" and spending time watching videos and having dinner with them. He did say that what he did was wrong and that he "must have been crazy." "With every week that I held my daughter, my situation got crazier," he said through his lawyer. "I repeatedly thought about whether I should let her go or not." But he kept her prisoner through seven pregnancies.

As Elisabeth's successful pregnancies showed, the body can handle realities against which the mind revolts. Max Friedrich, head of Vienna's University Clinic for Pediatric and Adolescent Psychiatry, treated Natascha Kampusch, an Austrian who was held hostage from 1998 to 2006 in a kidnapper's cellar. He says the greatest challenge for the Fritzls will be adjusting mentally to their new reality. Kampusch, now 20, spent a month in a Vienna hospital and a further five months in an assisted-living facility before she was able to begin with formal schooling. But she had experienced at least some direct contact with the world outside her prison, both because she was abducted as a 10-year-old and because she was periodically allowed out during her captivity; the Fritzls were kept imprisoned without reprieve. "Time went by very slowly [in the cellar], and we want to maintain this slow pace for them," says Dr. Berthold Kepplinger, the director of the Amstetten clinic where the family is being treated.

Psychologists say the bond between the children may help with their treatment. But their macabre upbringing raises an array of emotional concerns, not least for their long-term sexual development. Exposed to perversion from a young age, it may prove difficult for them to navigate future romantic relationships. Kevin Browne, Professor of Forensic Child Psychology at the University of Liverpool, says proximity to such extreme abuse can result in frigidity, promiscuity, or even abuse in later life.

While trying to steer them toward normal lives, their carers will also have to decide the extent to which the Fritzls are not just patients, but scientific subjects. In the 1970s, studies of a feral child, "Genie," who hadn't spoken with humans until the age of 13, helped to confirm several hypotheses relating to how language is acquired. Psychologists will likely be equally interested in studying the psychosocial development of the Fritzl children in such a deprived environment.

Getting access to them may be difficult, however. Their doctors have understandably made it clear that the Fritzls' rehabilitation is the priority. "The family has suffered a lot," says Kepplinger. "They require silence and a calm atmosphere." Friedrich agrees: "We have learned from the Kampusch case to pay even more attention to the protection of the victims. These are human beings — children — and not animals in a zoo. They have a right to the preservation of their dignity."

Already, says Kepplinger, the family's health is visibly improving, thanks to a more balanced diet, light and fresh air. He notes that the 5-year-old boy, Felix, in particular, "is getting more and more lively. He's fascinated by contact. He's fascinated by jokes and humor." According to one newspaper report, when Felix first saw the sun in April he cooed with joy. After years of unimaginable bleakness, it is finally time to step into the light. With reporting by Bethany Bell/Amstetten, Ursula Sautter/Bonn and D.J. Siegel/London

The original version of this story was updated with information from an interview published in an Austrian magazine.