Athens, Ohio, is the setting of the most sustained effort in the book to treat Billy Milligan outside a prison or maximum-security hospital. At the Athens Mental Health Center, Dr. David Caul offers a program that joins psychiatric care to gradually increased freedom, while courts, parole authorities, hospital staff, and an anxious public continually shape how much autonomy Milligan can exercise. His departure from Athens and return after two and a half years elsewhere make the city more than a place of treatment: it becomes the contested possibility of living under care without being defined only by confinement.

Setting and Admission

The Athens Mental Health Center stood among Victorian buildings on a snowy hill overlooking the campus of Ohio University. On the evening Billy Milligan arrived, officers led him from the van up the steps of an old red-brick building and through a door marked for admissions and intensive treatment. The approach was physically imposing, but the institution’s later role in the story differed from the continuously observed, locked ward he had known at Harding Hospital. In Athens, his care would take place in a setting where patients could, under conditions, leave the grounds.

The choice of Athens had been made in anticipation of Milligan’s trial and its possible outcome. Harding Hospital was considered too expensive for continued treatment, and the defense needed a state institution with relevant clinical expertise. Dr. Cornelia Wilbur recommended Dr. David Caul, medical director of the Athens Mental Health Center, who had treated several people with multiple personalities. After the court found Milligan not guilty by reason of insanity on counts two through ten, Judge Richard B. Metcalf committed him to the center in Dr. Caul’s custody. The ruling connected the city’s hospital to a legal disposition: treatment would follow the acquittal, rather than a return to ordinary liberty.

Treatment and Expanding Freedom

Dr. Caul framed the move as a new phase of care. Milligan was to be regarded as a patient, not as a criminal being punished for past acts, and recovery depended on his willingness to work with the different personalities and bring himself together. That approach gave Athens a distinct place in the narrative: it was where treatment could address Milligan’s condition while also recognizing him as a participant in his own progress.

The program combined general therapy intended to strengthen Milligan’s control of consciousness with hypnotherapy and autosuggestion techniques for tension. Weekly group sessions with two other patients experiencing multiple personality helped him understand his condition through comparison. As his switching became less frequent and Dr. Caul judged him to be improving, privileges were extended in stages. Milligan first left the building with an attendant, then signed himself out for short walks on the grounds. He used those walks to test pollution levels at points along the Hocking River, kept a chart of his moods, and planned to take physics, biology, and art classes at Ohio University in the spring of 1979.

Milligan then asked to go into town for practical purposes, including a haircut, a bank visit, legal business, and purchases of art supplies and books. At first, two hospital employees accompanied him; after those outings went well, Dr. Caul reduced the accompaniment to one. Students who recognized Milligan from newspaper and television coverage waved to him, a response that helped him imagine that public hostility was not universal. For Milligan, these walks were therefore not simply errands: they were a test of whether treatment could restore ordinary contact with the community.

He eventually sought permission to leave the hospital grounds unattended, arguing that he had been a good patient, had learned to trust people around him, and should be trusted in turn. Dr. Caul agreed after consulting Superintendent Sue Foster and law-enforcement officials. The conditions required the hospital to notify the Athens police and the Adult Parole Authority in Lancaster whenever Milligan left the grounds alone or returned. His agreement to follow those rules made the privilege possible, but also kept his movement tied to formal oversight.

Public Attention and Institutional Limits

The growing freedom attracted scrutiny beyond the hospital. In December, the Athens Messenger interviewed Milligan about his past, abuse, attempted suicide, and the influence of the other personalities. The reporter also raised the concern that he might pose a danger if allowed to leave an open ward. This question foreshadowed the conflict that would surround his treatment: the hospital’s assessment of his progress did not settle the community’s concerns about risk.

After Milligan’s March 1, 1979 review hearing, he was recommitted to the Athens Mental Health Center for another six months. At the same time, he faced the prospect that discharge would lead to his arrest as a parole violator and a return to prison for the Gray Drug Store robbery, as well as possible consequences connected with earlier roadside assaults. His Athens attorneys sought to have his earlier guilty pleas dismissed, arguing that he had been mentally ill and unable to assist in his defense when those pleas were entered. Thus, the hospital stay was shaped not only by clinical progress but by unresolved convictions and the possibility that recovery could return him to custody.

Public alarm intensified as newspaper coverage criticized Milligan’s unsupervised outings. Frightened Columbus readers and parents of Ohio University students contacted university president Charles Ping, who sought clarification from the hospital. State legislators Claire “Buzz” Ball, Jr., and Mike Stinziano criticized the hospital and Dr. Caul and pressed for hearings and changes to the law governing not-guilty-by-reason-of-insanity cases. The controversy showed how quickly a treatment arrangement could become a public and political dispute, with a patient’s freedom treated as evidence about the safety of the community and the adequacy of the law.

Removal and Return

Athens could not protect Milligan from institutional conflict within the hospital itself. After publicity and his reaction to it upset staff on the Admissions and Intensive Treatment ward, workers demanded changes to his treatment plan and threatened a strike. They called for day-to-day authority to pass to the staff team and for Dr. Caul to restrict his role to medical and therapeutic matters. Concerned that Milligan might otherwise be sent to Lima, Dr. Caul reluctantly accepted the change. Social worker Donna Hudnell prepared a contract placing limits on visitors, calls, money, possessions, painting, and other privileges. The restrictions made continued treatment in Athens conditional on compliance and sharply reduced the independence that had been built through the earlier stages of care.

The legal and institutional situation eventually carried Milligan away from the city. On October 4, 1979, he was handcuffed and shackled and transferred 180 miles to Lima State Hospital. He later spent time at the Dayton Forensic Center, a maximum-security institution. In November 1980, he was still there, unable to paint and hoping that a later hearing would return him to Athens, where he believed Dr. Caul could treat him and help restore the Teacher. The account records worsening disconnection among the personalities during this period: communication faltered, lost time increased, and the Teacher had not returned by the time Milligan’s later transfer was being considered.

On April 8, 1982, Judge Jay Flowers ordered the Department of Mental Health to transfer Milligan back to the Athens Mental Health Center. The order allowed painting and woodworking but called for close supervision away from the ward and required court notification before Milligan could leave the grounds. He returned on April 15, after two and a half years in three Ohio maximum-security hospitals. The transfer restored access to Athens and its treatment resources, but not the earlier degree of freedom: the new conditions explicitly subjected off-ward movement to supervision and judicial notice.

Significance

Athens is presented through a sustained contrast between therapeutic trust and systems of control. At first, walks along the Hocking River, escorted trips into town, and the possibility of study at Ohio University make treatment visible as a gradual return to ordinary activity. Notifications to police and parole officials, public criticism, staff demands, and restrictive contracts show how that return could be narrowed or reversed. The hospital is neither a simple refuge nor merely another prison; its meaning changes with the privileges it grants and the authorities empowered to limit them.

The city also anchors the distinction between a legal finding and a clinical future. Milligan’s acquittal did not end his confinement, while a diagnosis did not by itself determine where he would be treated or how freely he could move. Athens offered a clinician and a setting associated with ongoing treatment, yet that possibility depended on court orders, institutional decisions, and public tolerance. His 1982 return therefore closes this part of the story without resolving it: he is back with Dr. Caul, but his internal communication remains badly disrupted and the Teacher has not returned. Athens remains both the place where recovery is pursued and the measure of how fragile that pursuit is.