Cleveland women start road to recovery after nightmare

Year after year, the clock ticked by and the calendar marched forward, carrying the three women further from the real world and pulling them deeper into an isolated nightmare.

Now, for the women freed from captivity inside a Cleveland house, the ordeal is not over. Next comes recovery — from sexual abuse and their sudden, jarring re-entry into a world much different from the one they were snatched from a decade ago.

Therapists say that with extensive treatment and support, healing is likely for the women, who were 14, 16 and 21 when they were abducted. But it is often a long and difficult process.

"It's sort of like coming out of a coma," says Dr. Barbara Greenberg, a psychologist who specializes in treating abused teenagers. "It's a very isolating and bewildering experience."

The physical healing may take longer for some than for others. Michelle Knight may need reconstructive surgery for injuries suffered at the hands of her accused attacker, CBS Cleveland affiliate WOIO-TV reports.

Her grandmother, Deborah Knight, confirmed the information, telling WOIO-TV Thursday: "When she was severely beaten, he had beat her so bad in the face, she has to have facial reconstruction, and she's lost hearing in one ear."

Knight was released from MetroHealth Friday, the last of the three women to do so.

In the world the women left behind, a gallon of gas cost about $1.80. Barack Obama was a state senator. Phones were barely taking pictures. Things did not "go viral." There was no YouTube, no Facebook, no iPhone.

Emerging into the future is difficult enough. The two younger Cleveland women are doing it without the benefit of crucial formative years.

"By taking away their adolescence, they weren't able to develop emotional and psychological and social skills," says Duane Bowers, who counsels traumatized families through the National Center for Missing and Exploited Children.

"They're 10 years behind in these skills. Those need to be caught up before they can work on reintegrating into society," he says.

That society can be terrifying. As freed captive Gina DeJesus arrived home from the hospital, watched by a media horde, she hid herself beneath a hooded sweatshirt. The freed Amanda Berry slipped into her home without being seen.

"They weren't hiding from the press, from the cameras," Bowers says. "They were hiding from the freedom, from the expansiveness."

In the house owned by Ariel Castro, who is charged with kidnapping and raping the women, claustrophobic control ruled. Police say Castro kept them chained in a basement and locked in upstairs rooms, that he fathered a child with one of them, and that he starved and beat his captives into multiple miscarriages.

In all those years, they only set foot outside of the house twice — and then only as far as the garage.

"Something as simple as walking into a Target is going to be a major problem for them," Bowers says.

Jessica Donohue-Dioh, who works with survivors of human trafficking as a social work instructor at Xavier University in Cincinnati, says the freedom to make decisions can be one of the hardest parts of recovery.

"'How should I respond? What do they really want from me?'" Donohue-Dioh says, describing a typical reaction. "They may feel they may not have a choice in giving the right answer."

That has been a challenge for Jaycee Dugard, who is now an advocate for trauma victims after surviving 18 years in captivity — "learning how to speak up, how to say what I want instead of finding out what everybody else wants," Dugard told ABC News.

Another step toward normalcy for the three women will be accepting something that seems obvious to the rest of the world: They have no reason to feel guilty.

"First of all, I'd make sure these young women know that nothing that happened to them is their fault," Elizabeth Smart, who was kidnapped at age 14 and held in sexual captivity for nine months, told People magazine.

Donohue-Dioh says that even for people victimized by monstrous criminals, guilt is a common reaction. The Cleveland women told police they were snatched after accepting rides from Castro.

"They need to recognize that what happened as a result of that choice is not the rightful or due punishment. That's really difficult sometimes," Donohue-Dioh says.

Family support will be crucial, the therapists say. But what does family mean when one member has spent a decade trapped with strangers?

"The family has to be ready to include a stranger into its sphere," Bowers says. "Because if they try to reintegrate the 14-year-old girl who went missing, that's not going to work. That 14-year-old girl doesn't exist anymore. They have to accept this stranger as someone they don't know."

Natascha Kampusch, who was kidnapped in Austria at age 10 and spent eight years in captivity, has said that her 2006 reunion with her family was both euphoric and awkward.

"I had lived for too long in a nightmare, the psychological prison was still there and stood between me and my family," Kampusch wrote in "3096 Days," her account of the ordeal.

Kampusch, now 25, said in a German television interview that she was struggling to form normal relationships, partly because many people seem to shy away from her.

"What a lot of these people say is, what's more important than what happened is how people react," says Greenberg, the psychologist.

The world has reacted to the Cleveland women with an outpouring of sympathy and support. This reaction will live on, amplified by the technologies that rose while the women were locked away.

Yet these women are more than the sum of their Wikipedia pages. Dugard, Smart and other survivors often speak of not being defined by their tragedies — another challenge for the Cleveland survivors.

"A classmate will hear their name, or a co-worker, and will put them in this box: This is who you are and what happened to you," Donohue-Dioh says. "Our job as society is to move beyond what they are and what they've experienced."

"This isn't who they are," Dugard told People. "It is only what happened to them."

Still, for the three Cleveland women, their journey forward will always include that horrifying lost decade.

"We can't escape our past," Donohue-Dioh says, "so how are we able to manage how much it influences our present and our future?"