Maria Monaco spent the last 18 years of her life locked in a bare room in a sleepy southern town, fed in tin bowls and watched over by her elderly mother and siblings as she slept in a filthy bed.
Investigators and experts say the case of the woman imprisoned in her family's home in Santa Maria Capua Vetere, near Naples, is only the most recent example of a widespread stigma attached to mental and physical disability in many poor areas of Italy.
Monaco, now 47, had a history of psychiatric problems when her family decided to lock her up, allegedly because she had become pregnant out of wedlock, investigators say.
When police were brought in last week after a neighbor called to protest about the smell rising from the apartment, they found the woman in the room with a bed with soiled sheets, a filthy toilet and sink, as well as plastic bottles of water and a metal dog bowl used to feed her.
Police arrested Monaco's brother, a farmhand, and sister, who worked in a nursery school, and put her ailing, widowed, 80-year-old mother under house arrest. They are being investigated on suspicion of mistreatment and kidnapping.
Monaco's now 17-year-old son grew up with relatives and knew she was his mother, though he was told that she was too sick for visits, said prosecutor Antonio Ricci. The same was told to inquisitive neighbors or distant relatives.
The Italian media have compared Monaco's segregation to other abuse stories that have surfaced recently in Austria, including the case of Elisabeth Fritzl - who had seven children from her father and was held captive underground for 24 years in the family's home west of Vienna - and of Natascha Kampusch, the Austrian girl abducted at age 10 and held in an underground cell for eight-and-a-half years by her kidnapper.
But far from being an isolated abuse case, Monaco's fate is shared by some in rural parts of Italy, where a mix of embarrassment and ignorance pushes families to segregate relatives who have mental or physical disabilities, Ricci said.
"This is a particularly horrible case," the prosecutor said. "But this measure is often taken with the mentally ill, also because there is little access to healthcare in the most isolated areas."
Ricci said investigators are trying to find out who fathered Monaco's son, in the hope that he could help determine what kind of psychiatric problems she had before being locked up.
They are also probing why authorities were not alerted earlier. The woman has been receiving a monthly disability check since the late 1980s and should have been paid occasional calls by health officials, the prosecutor said.
Gianfranco Carbone, a lawyer for Monaco's family, denied that the woman was locked up because of the pregnancy. He blamed her "deplorable" condition on her refusal to let anyone wash her or change her.
Then why not call in doctors for help? "Probably because of ignorance and shame," Carbone said.
Experts say those factors were at work in similar cases in recent years across Italy.
Two years ago the country was shocked by reports of a woman in Pescara, central Italy, who lived for 30 years in the bathroom of the home of her mother and stepfather because she was mentally retarded and was born from a previous relationship.
In 2005, parents near Palermo, Sicily, were accused of not giving enough food to their 3-year-old daughter, who had Down syndrome, then failing to help while she choked to death on a piece of food.
"It's almost as if the family feels guilty for siring a person with such problems," said Andrea Materzanini, head of the psychiatry ward at a hospital in Iseo, near Milan.
Elvira Reale, a psychologist and director of a women's mental health center in Naples, said the stigma of disability can mask prejudice against women who display behavior considered too bold in the country's more conservative backwaters.
Women who behave unconventionally, particularly sexually, can be branded as mentally ill, Reale said.
Until the late 1970s, it was common for such women to end up spending their lives in a mental institution upon doctor's orders, she said. A 1978 reform shut down mental institutions, and hospitalization in psychiatric wards must be limited in time.
Monaco's case appears to conform to this age-old pattern, Reale said.
