Athens Mental Health Center

Athens Mental Health Center is both a treatment setting and a contested threshold in William Stanley Milligan’s story: the place where a court-ordered patient was offered therapy and gradually greater freedom, and from which he was later removed amid public and institutional pressure. Dr. David Caul’s work there gave Milligan a chance to continue treatment after his insanity acquittal, but the center’s changing rules and the interruptions to that work made the hospital’s promise of recovery uncertain.

Setting and Selection for Treatment

Athens Mental Health Center was a state hospital in Athens, Ohio, under the medical direction of Dr. David Caul. Dr. Cornelia Wilbur recommended Caul because he had treated several people with multiple personalities and was recognized for experience in the field. Caul did not immediately commit the hospital to accepting Milligan: he first said he needed to consult the superintendent, Sue Foster, who would discuss the question with state mental-health officials. He nevertheless agreed to travel to Columbus for a meeting about the case. His experience and the recommendations of Wilbur and Dr. Ralph Allison helped establish Athens as a possible alternative to continued confinement elsewhere.

The book places the center on a hill overlooking the Ohio University campus. Milligan arrived in the evening under the custody of two officers, who led him from their van into an old red-brick hospital building. The account emphasizes the change in setting: the transfer was not simply a return to ordinary life, but entry into another institution, now chosen for treatment. The court committed him to Athens in the custody of Caul, making the physician responsible for care within a legal arrangement that continued to govern Milligan’s liberty.

The decision followed a legal finding about Milligan’s condition at the time of the offenses. Judge Jay C. Flowers dismissed one rape count for lack of corroborating evidence and a similar pattern of conduct. On the insanity defense, the medical evidence was stipulated: the doctors testified that Milligan had been mentally ill, unable to distinguish right from wrong, and unable to refrain from the acts. After reviewing the psychiatrists’ recommendations, Judge Metcalf ordered commitment to Athens. The hospital therefore received a patient whose clinical needs and legal status were closely joined, but not interchangeable: the verdict addressed responsibility for past acts, while treatment and later review would determine where he was held and what freedom he could exercise.

Admission and the Work of Treatment

The apparent stability of Milligan’s personality fusion did not survive the transition intact. Caul understood that the fusion was fragile and that a stressful event such as a trial could be followed by unfusion. When dissociation occurred after Milligan’s arrival, Caul responded by trying to build his confidence rather than treating the change as evidence that treatment had failed. He reminded Milligan that the court had found him not guilty and framed the hospital as a new life in which progress depended on working with Billy and bringing himself together. About a week after the arrival, Caul began therapy with him.

Treatment at Athens combined several approaches. Caul’s general therapy was intended to strengthen Milligan’s control of consciousness; he also used hypnotherapy and taught autosuggestion techniques to help reduce tension. Weekly group sessions with two other patients with multiple personalities gave Milligan a way to observe the condition in others as well as himself. The book reports that switching became less frequent and that Caul believed Milligan was improving. In the early weeks of 1979, the writer visited often as the Teacher described the past and the other personalities learned what they had experienced. Shawn, who was deaf, was the exception to the account that the others listened and learned their histories.

Permission to leave the grounds expanded in stages. At first Milligan could go out only with two hospital employees; after these outings went well, Caul allowed him to go with one attendant. Students who recognized Milligan from newspaper and television coverage waved to him. Their recognition mattered within the account because it offered a contrast to the hostility he feared: he took the greetings as a possible sign that not everyone hated him and that society might not be entirely against him. The outings thus carried both a practical change in supervision and a social meaning for a patient whose public identity had been shaped by the crimes and the diagnosis.

Publicity, Oversight, and Restrictions

The increased freedom became a source of controversy. After a March 1, 1979 review hearing, Milligan was recommitted to Athens for another six months. At the same time, he knew that discharge could lead to arrest as a parole violator and a return to prison for the remaining three years of his sentence for the Gray Drug Store robbery. He also faced the possibility of being declared a probation violator and serving a consecutive sentence for the roadside-rest assaults. The prospect of treatment and the prospect of renewed incarceration therefore remained entangled: improvement could bring him closer to discharge, but discharge did not necessarily mean release from legal consequences.

A newspaper report described Milligan as being allowed to leave the hospital grounds unsupervised and to take weekend visits with relatives. The report prompted public criticism and demands for an investigative hearing at Athens from Representatives Stinziano and Ball. Under mounting attacks and almost daily headlines, Caul and Foster asked Milligan to give up both his furloughs and the privilege of leaving the grounds unattended until the controversy subsided. His earlier progression from two attendants to one, and the freedom that followed, was reversed by a dispute that concerned public confidence as much as his day-to-day clinical progress.

The Admissions and Intensive Treatment ward staff also challenged the treatment arrangement. Upset by the publicity and Milligan’s reaction to it, staff members demanded changes and threatened to strike. Some believed Caul was spending too much time with him. They wanted the staff team to take over day-to-day management while Caul limited his role to medical and therapeutic matters. Caul reluctantly agreed because he hoped to prevent Milligan from being sent to Lima State Hospital. A social worker drew up a treatment contract that restricted Milligan’s conduct toward staff; a first violation of one clause could lead to restrictions on the writer’s visits. The episode shows how the hospital’s internal allocation of authority could affect treatment directly, including access to a visitor whose presence had become part of the account of Milligan’s life there.

Removal and Return

The Teacher’s reappearance marked a further development during Milligan’s time at Athens. On September 17, the writer recognized the Teacher in Milligan’s knowing smile, clear-eyed look, and nod as they met in the corridor of the intensive-treatment ward. The following day, after Milligan returned from Lancaster agitated and fearful of being shot again, Caul allowed a furlough at the Hocking Valley Motor Lodge in nearby Nelsonville. Milligan understood that his sister’s house might also be a target, and the plan was for him to stay at the motel with his easel, paints, and canvas so he could work undisturbed. He checked in under a false name, but could not relax. Voices he identified as belonging to the undesirables interfered with painting and sleep, and he became afraid to return either to his sister’s home or to Athens.

Later, an investigation on the ward intensified the pressure. The state highway patrol requested that the intensive-treatment ward be temporarily locked so that the male patients could be questioned about accusations involving Milligan and Gus Holston. Staff members worried about how Milligan would react when told; some remembered that Ragen had once threatened attendants with a broken drinking glass. The account does not resolve the accusations in this scene. It does show the staff’s concern, the temporary restriction of the ward, and the return of a feared episode of violence to their thinking about Milligan’s care.

At two o’clock on October 4, 1979, Milligan was handcuffed and belt-shackled and driven 180 miles to Lima State Hospital for the Criminally Insane. He had time to say goodbye only to Caul. The transfer ended the period in which Athens had been his treatment setting and made physical distance part of the separation from the doctor who had been working with him. Milligan later spent time in three Ohio maximum-security hospitals. At Lima, he read, wrote, and sketched, but was not allowed to paint. He looked forward to a 180-day hearing and hoped to return to Athens, believing Caul could treat him, fuse him again, and bring back the Teacher.

On April 8, 1982, Judge Flowers ordered the Department of Mental Health to transfer Milligan back to Athens. The order allowed him to paint and do woodworking, while calling for close supervision off the ward and notice to the court before he could leave the grounds. Milligan returned on April 15, after two and a half years in maximum-security hospitals. Caul then faced the difficult task of undoing the damage of the intervening period and trying to put the pieces back together; the account makes clear that no one knew how long this would take.

Place in the Narrative

Athens is not portrayed as a simple refuge from confinement. It is a hospital whose therapeutic purpose depended on clinical judgment, staff cooperation, and a degree of public and legal trust. Its permissions changed: escorted outings widened, controversy curtailed them, and ward pressures altered who managed Milligan day to day. The return in 1982 restored access to Caul and to painting and woodworking, but under explicit supervision and court notification requirements. The setting’s significance lies in that unresolved tension between treatment and control: Athens offered a route back to care, while its institutional limits remained present at every stage.

The book’s own relation to Athens reinforces its role as a place of testimony. The writer first met the twenty-three-year-old Milligan there shortly after the courts had sent him to the center. Milligan asked for his story to be written, saying that the deeper secrets of his inner people had not been revealed, and that he wanted the world to understand his illness. The account was developed not only from hundreds of meetings and conversations with Milligan but also from interviews with sixty-two people whose lives touched his. Athens thus became both the site of treatment and the point of departure for a narrative assembled from Milligan’s account, the writer’s visits, and the testimony of others.