Billy is sent to Athens Mental Health Center for open treatment

Billy Milligan’s admission to Athens Mental Health Center placed him in an open treatment setting after a court found him not guilty by reason of insanity on most of the charges before it. The move reflected a new legal framework that treated him as a mentally ill patient rather than a criminal, and a clinical judgment that he should be treated by Dr. David Caul. Yet the arrival itself carried the marks of custody, while the freedom offered by the hospital would prove conditional and vulnerable to institutional pressure.

Legal and Clinical Grounds

The path to Athens began with a question about Billy Milligan’s ability to participate in his defense, not with a final determination of his responsibility at the time of the alleged offenses. In January 1978, after Gary Schweickart and Judy Stevenson continued to represent their client despite a letter dismissing them, the public defenders’ office paid for an evaluation by clinical psychologist Dr. Willis C. Driscoll. Testing on January 8 and 13 produced an IQ score of 68, which Dr. Driscoll attributed in part to depression. His report diagnosed acute schizophrenia and described a severe disturbance of identity and reality testing; he concluded that Billy Milligan could not adequately understand events or assist in his own defense, and recommended hospitalization for further assessment and possible treatment.

On January 19, the defense presented that report to Judge Jay Flowers as evidence that Billy Milligan could not help with his case. The dispute that followed concerned how information from a court-ordered examination by Southwest Community Mental Health Center could be used. The defense feared that statements made to its forensic unit might later be used against its client; the parties reached a compromise limiting such questioning to the circumstance in which Billy Milligan testified in his own defense. This earlier competency dispute was distinct from the later question of criminal responsibility: the report addressed his capacity to participate in proceedings, whereas the trial considered his mental state when the charged acts occurred.

By late November, the defense was preparing for a further legal change. A new Ohio law, due to take effect on December 1, required that people found not guilty by reason of insanity be treated as mentally ill patients rather than criminals. It also required placement in the least restrictive environment consistent with safety and placed commitment to a state mental institution under probate-court jurisdiction. Because Billy Milligan’s trial was set for December 4, he would be among the first defendants dealt with under the new provisions. Harding Hospital was ruled out on financial grounds, so the defense needed a state facility able to provide specialized care. Dr. Cornelia Wilbur recommended Dr. Caul, medical director of Athens Mental Health Center, citing his experience treating people with multiple personalities. The recommendation made Athens a proposed treatment destination before it became the court’s decision.

Verdict and Commitment

At trial, Judge Jay Flowers dismissed the first rape count, noting the absence of corroborating evidence and of a similar modus operandi. On counts two through ten, the medical evidence had been stipulated. The doctors’ evidence established, in the judge’s account, that Billy Milligan was mentally ill at the time of the offenses, could not distinguish right from wrong, and could not refrain from the acts. With no evidence to the contrary, Judge Flowers found him not guilty by reason of insanity on those counts. The ruling was a legal conclusion about criminal responsibility; it did not itself amount to a cure or settle where treatment would take place.

After lunch, Probate Judge Metcalf reviewed the psychiatrists’ recommendations and committed Billy Milligan to Athens Mental Health Center in Dr. Caul’s custody. The decision put the new law’s treatment framework into practice: rather than sending him directly to the state hospital that had traditionally received defendants after such verdicts, the court selected a facility whose clinicians were considered capable of addressing his condition. Billy Milligan said that he wanted to become a citizen again and learn life over. The statement expressed an aspiration, not an assurance that the institutional transition would be simple.

The departure from court was abrupt. Billy Milligan was taken away before Judy Stevenson and Gary Schweickart could return to say goodbye. An officer handcuffed him and hurried him to a police van; another officer gave him hot coffee, which spilled onto his new suit as the van turned. He did not know what awaited him in Athens and feared that the hospital might amount to another prison. He also understood that the Adult Parole Authority regarded his possession of guns as a violation of parole and probation, leaving open the possibility of prison after treatment. Thus, the court’s decision changed his immediate destination without erasing the legal and custodial uncertainties surrounding his future.

Arrival at Athens

The van reached Athens near dark. The hospital stood among Victorian buildings on a snowy hill overlooking Ohio University. For Billy Milligan, the unfamiliar approach did little to resolve his fear of confinement. The officers took him to the third floor, through a heavy door marked for admissions and intensive treatment. Inside, however, the ward looked less like a conventional locked institution than a small residential hotel: carpet, chandeliers, drapes, leather chairs, and a nurses’ station arranged like a reception desk.

Dr. Caul, who had seen Billy Milligan brought into the admissions office in handcuffs, immediately ordered that they be removed. This response made the difference between custody and treatment visible in a practical gesture. Billy Milligan rubbed his wrists and asked what would happen to him; Dr. Caul began by asking his name. The scene contrasts the officers’ transfer of a prisoner with the physician’s reception of a patient, without making the transition effortless: Billy Milligan arrived uncertain, under escort, and newly separated from the attorneys who had accompanied his case.

The ward’s everyday rules made its open status concrete. After breakfast, a staff member explained that Billy Milligan could walk through the hospital by signing out on a sheet posted on the ward. Leaving the building for the grounds would require Dr. Caul’s later approval, but there were no walls or fences around those grounds. The initial freedom was therefore real but graduated: movement within the hospital was allowed, while access beyond it depended on clinical judgment. The setting offered a marked contrast with the locked special-care unit at Harding Hospital, where Billy Milligan had previously been placed under constant observation.

Dr. Caul framed the move as a beginning rather than a declaration that the past no longer mattered. He told Billy Milligan that the court had found him not guilty and that the hospital did not regard him as a criminal. Recovery, he explained, would depend on how Billy Milligan worked with himself and sought to become well. This approach joined legal status to a therapeutic aim while keeping the two distinct: the verdict removed criminal guilt for the specified counts, but treatment and personal integration remained unfinished work.

The Limits of Openness

The later course of Billy Milligan’s treatment shows that an open admission did not guarantee lasting freedom of movement or a stable therapeutic arrangement. After publicity and conflict over his care, staff on the Admissions and Intensive Treatment ward demanded changes and threatened to strike. Some believed Dr. Caul spent too much time with Billy Milligan and pressed for the team to take over day-to-day management. Dr. Caul reluctantly agreed, partly to prevent Billy Milligan from being sent to Lima. Social worker Donna Hudnell then prepared a treatment contract imposing restrictions: visits and telephone calls were limited, sharp or glass objects were barred from his room, spending was capped, painting supplies were available only under supervision, and privileges would be restored in stages after compliance.

The contrast is consequential. At Athens, the absence of perimeter fences and permission to walk inside the hospital signaled an alternative to imprisonment; later restrictions made access to visitors, money, art materials, and ordinary privileges subject to staff control. In October 1979, after a confrontation near the hospital, Billy Milligan was handcuffed and shackled and transferred 180 miles to Lima State Hospital for the Criminally Insane. A later court finding described his multiple-personality condition as a mental illness and cited risks to himself and others in ordering hospitalization. In November 1980, he was moved to the more secure Dayton Forensic Center. These subsequent decisions do not undo the significance of the Athens admission, but they show its limits: the initial commitment opened a less restrictive route to treatment, while later assessments, incidents, and institutional decisions repeatedly altered the degree of freedom available to him.