Although they’ve never met, Henry R. Bachmann of Port Wentworth, Ga., and Frank L. Fitzpatrick of Cranston, R.I., have a lot in common.

Both men, now in their early 50s, were molested by Roman Catholic priests in the mid-1960s when they were altar boys. For decades, both repressed the memory of what had happened – a festering secret that metastasized into consuming self-hatred, unfocused anger, and serious sexual problems. Both men still take medication to treat depression and anxiety stemming from the abuse inflicted by men they revered.

Despite their many overt similarities, Bachmann, 51, and Fitzpatrick, 52, have fared quite differently. Bachmann says he cannot stop thinking about the sadistic “games” the Rev. James Gummersbach repeatedly forced on him in the basement of a St. Louis church 38 years ago. He dropped out of school, battled alcoholism, attempted suicide, has been diagnosed with predatory sexual disorders and spent time in a mental hospital and jail. He is now unemployed.

Fitzpatrick has fashioned a satisfying life, juggling careers as an insurance investigator, advocate for the abused and, most recently, a music teacher. Nevertheless, Fitzpatrick said, he still bears the psychological scars inflicted by James R. Porter, a former priest serving a 20-year prison term in Massachusetts.

Their disparate experiences illuminate one of the most important and least explored questions in the sex-abuse crisis confronting the Roman Catholic Church: Why are some victims permanently crippled by child sexual abuse while others can transcend the trauma? This issue likely will assume greater importance in the coming months, both for adult victims coming forward now and for younger victims and their families, who may more readily disclose abuse because they’re more likely to be taken seriously.

The quartet of victims who addressed the Catholic bishops’ conference in Dallas movingly described their devastation: shame, guilt, substance abuse, promiscuity, mental illness, suicide. But psychologists who treat child abuse victims caution that none of these problems is inevitable. Nor can they predict with certainty who is likely to be severely damaged and who will prove more resilient.

“Unfortunately there’s this sense that everyone who is sexually abused as a child is doomed for life, which is not true,” said Anthony Mannarino, professor of psychiatry at the Medical College of Pennsylvania.

Typically, children who tell an adult soon after they were molested, who receive prompt treatment and whose perpetrators face swift consequences fare best – all factors absent in the cases of Bachmann and Fitzpatrick and most other victims of priests. Those whose families are unsupportive or chaotic, who carry the secret for years, or who are not believed tend to do worse.

“The truth is, it’s hard to say why one person does well and another doesn’t,” said David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire.

“Being sexually abused is not a life sentence, although it can be,” said psychologist Christine Courtois, clinical director of the Posttraumatic Disorders Program at the Psychiatric Institute of Washington. “I think 80 percent of people can heal” with proper support and therapy, she said. “But not everyone’s going to make it.”

Most behavioral scientists agree that traditional psychotherapy can’t overcome abuse. What seems to work best is a combination of cognitive and behavioral therapy with twin goals: robbing traumatic memories of their power by exposing them to a victim in a protected setting, and altering the distorted thoughts and dysfunctional behavior that accompany such memories.

Cognitive techniques focus on changing thoughts; the most common is belief that the abuse was the victim’s fault. Behavioral strategies aim to change the harmful response to those thoughts, such as heavy drinking or binge eating. Medications that reduce depression and anxiety are often used.

“One of the things that happens is that people are so filled with shame and guilt that it has a dramatic impact on their self-concept throughout their lives,” said Stuart Grassian, a Boston psychiatrist who has treated dozens of victims of Massachusetts’s most notorious pedophile priests – those of Porter and John Geoghan.

Support groups also play a critical role. Fitzpatrick formed a national support group called Survivor Connections from a nucleus of Porter’s 330 known victims. “What we found is that even though there were so many of us, a lot of people thought they were the only one,” he said.

Invariably, victims of priests describe themselves as unusually religious children, another trait exploited by their abusers.

“The easiest targets are the devout, because they can be conned more easily,” said psychologist Gary Schoener of Minneapolis, who has counseled hundreds of clergy victims. Priests tend to inflict maximum damage on their devout victims because Catholicism teaches that priests are God’s representatives on Earth, worthy of complete obedience and trust. To children, it often seems as though God is abusing them, a violation that can forever destroy the refuge organized religion provides.

Bachmann was nothing if not devout. As a 13-year-old altar boy, he wanted to be a priest like his idol Gummersbach, who took him to baseball games and got him summer lawn-mowing jobs that helped support Bachmann’s needy family. When it was time to collect his pay, Gummersbach summoned the boy to the basement of the Church of the Immaculate Conception. He blindfolded Bachmann, tied his hands to an overhead pipe, stripped him and sodomized him.

Bachmann said his father, whom he described as a sporadically employed alcoholic, physically abused him, something he believes Gummersbach exploited.

“Perpetrators are very good at choosing boys they can compromise,” said New York psychoanalyst Richard Gartner, president of the National Organization on Male Sexual Victimization. “Either they’re having trouble at home or they have only one parent, and the perpetrator offers himself as savior, which just compounds the betrayal.”

Bachmann’s abuse was likely to be particularly damaging because it was prolonged, it involved both penetration and violence, and it occurred during early adolescence, a critical developmental phase. Studies have found that abuse that is infrequent and not physically invasive, and occurs when a victim is either younger or past adolescence, tends to cause less permanent injury.

Fitzpatrick said he isn’t precisely sure what the priest did to him or how often it happened. He said the first incident he remembers occurred when he was 12 and the priest made him eat a piece of mincemeat pie laced with drugs. When he woke up, Fitzpatrick said, he was lying on the floor on his stomach and Porter was on top of him.

“Adolescence is such a defining window,” said Peter Isely, a therapist who worked with clergy-abuse victims in a Milwaukee hospital. “For a lot of people this is the inaugural sexual act and it helps define how people feel about sex,” added Isely, who said he was molested at 13 by a priest.

Boys abused as teen-agers are more likely to worry they may be gay, although most experts believe sexual orientation is fixed earlier. Molested boys are more apt to become perpetrators themselves, sometimes to demonstrate that they are not victims, a trait regarded as female, psychologists say. Molested girls are more likely to become promiscuous or choose partners who abuse them. Among both sexes, depression, anxiety and substance abuse are common.

Fitzpatrick said that for years before his memory returned in 1989, he found it hard to trust anyone, was uneasy around priests without knowing why and worried he might be bisexual. Bachmann said he began stealing women’s underwear off clotheslines and peeping in windows around the time Gummersbach abused him. Several years later he developed a compulsive interest in pornography and began stalking women he spotted at shopping malls.

Bachmann said that for years he did not remember what Gummersbach had done to him because he had dissociated: He had put himself into a trance in which he did not consciously feel pain or terror and watched from outside his body, as though it was happening to someone else.

Terrifying flashbacks can occur decades later, triggered by a smell, sound or an incident. Bachmann said shards of memory began returning one afternoon at work in 1992, when his boss yelled at him. Fitzpatrick said he was lying on his bed at home when he heard heavy breathing and a crinkling sound and recalled the feeling of someone lying on top of him. For both men, a flood of memories soon followed.

Fitzpatrick said his parents were devastated when they learned that he and his three sisters had all been Porter’s victims; they haven’t been inside a Catholic church in more than a decade. Bachmann’s parents, now dead, sided with the church. They cut him off when he and his wife sued the St. Louis archdiocese, which shuffled Gummersbach from parish to parish for 40 years.

For Fitzpatrick, bringing Porter to justice was undeniably therapeutic. Porter was convicted in 1992, after Fitzpatrick laboriously tracked him down, recorded incriminating telephone conversations, rounded up dozens of other victims in the same town and persuaded skeptical law enforcement officials to prosecute.

“I’m very pigheaded,” he said. “I just kept focusing on the question of whether Porter was doing this to other kids and stopping it.”

Bachmann’s legal case ended more ambiguously. In 1999, five years after he sued the priest, the archbishop and the archdiocese, Bachmann received $25,000 and a letter of apology, admitting the abuse, from Gummersbach, now in a St. Louis retirement home.

That year a jury awarded Bachmann and his wife $1.2 million. The church appealed, challenging Bachmann’s contention that his memory of the abuse had been repressed. An appellate court overturned the verdict and ruled for the church on the grounds that the statute of limitations had expired.

“I feel all this anger that he was allowed to get away with it, that the church was allowed to get away with it,” Bachmann said. “I can’t forgive and I can’t forget. The thing is, I still feel like I’m responsible for what happened.”