Athens Mental Health Institution

Athens Mental Health Institution occupies a pivotal place in the account of Billy Milligan: it was the setting for his treatment under Dr. David Caul after his insanity acquittal, but also the site where that treatment became entangled with headlines, public fear, and increasingly restrictive control. The institution’s history in the book turns on a sharp contrast: Milligan was told that his criminal case was over and that he could begin a new life, yet the conditions under which that life might be rebuilt were repeatedly challenged from outside and within the hospital.

Identity and Role

The Athens-based psychiatric institution is introduced as the place to which the courts sent Milligan after his case. Daniel Keyes first met the twenty-three-year-old there, shortly after the transfer, when Milligan asked him to write his story. The institution thus serves not only as a site of care but as the point from which the book’s inquiry into Milligan’s inner life begins: the patient promised that the deeper secrets of his personalities had not been disclosed even to his attorneys or examining psychiatrists, and wanted the public to understand his illness.

Dr. David Caul, the institution’s clinical director, was central to Milligan’s treatment. After the acquittal, Caul emphasized that staff did not regard Milligan as a criminal and that his recovery depended on what he did in the hospital, including how he worked with Billy and sought to bring himself together. This approach framed the institution as a therapeutic setting in which progress required Milligan’s participation, rather than as a place of punishment for his past actions or those attributed to other personalities.

Treatment and the Promise of Open Care

The institution permitted Milligan to leave its grounds without supervision and to take weekend visits to relatives. Those arrangements became central to the public dispute over whether his treatment should allow such freedom. The Columbus Dispatch reported that he could roam Athens and leave the hospital, presenting the arrangement as a danger to the surrounding community. The report also cited expressions of concern from local residents and criticism from Judge Jay Flowers, who had found Milligan not guilty by reason of insanity.

The dispute was not limited to whether Milligan could leave. It reached the treatment itself. On April 7, the Dispatch reported that Milligan had been placed in a security ward after a faked drug overdose. As its attacks widened to include the hospital and Caul, Caul received abusive calls and death threats; the account describes him checking around his car and keeping a loaded revolver by his bed. The institution’s clinical decisions had become inseparable from the public image of a supposedly dangerous patient and a hospital accused of allowing him too much freedom.

Press Controversy and Internal Restrictions

During the controversy, superintendent Sue Foster said that treatment had been compromised by the press and by Milligan’s reaction to it. Mike Stinziano rejected the suggestion that the press was to blame simply for reporting the facts. At Stinziano’s and Claire “Buzz” Ball, Jr.’s request, Dr. Cornelia Wilbur came to Athens to assess the treatment. Her report praised Caul’s program and described setbacks as common in the treatment of multiple personalities; on her recommendation, the decision was made to keep Milligan at the institution.

Keeping him in Athens, however, required a change in how his care was managed. Staff on the Admissions and Intensive Treatment ward, distressed by the publicity and Milligan’s reaction to it, demanded changes and threatened to strike. They wanted Caul to surrender day-to-day management to the staff team and limit his role to medical and therapeutic matters. Caul reluctantly agreed, seeking to prevent Milligan’s transfer to Lima State Hospital.

Social worker Donna Hudnell then drafted a contract imposing detailed limits. Milligan was not to threaten staff members’ standing or character; a first violation could result in restricted visits. Glass and sharp objects were barred from his room, privileges required advance agreement, and incoming calls were prohibited. Outgoing calls were limited to his attorney, mother, or sister; visitors were restricted to a small named circle. He could not advise other patients, could withdraw no more than $8.75 a week, and could have only limited access to paint supplies under supervision. Finished paintings were to be removed weekly, and privileges could be restored in stages only after two weeks of compliance. The contract made the hospital’s therapeutic relationship increasingly dependent on rules governing Milligan’s speech, contacts, possessions, money, and art.

Transfer and Legislative Consequences

The institution ultimately lost authority over Milligan’s placement. After evidence concerning an incident near the hospital, Judge Jones granted the attorney general’s request to send him to Lima. On October 4, 1979, Milligan was handcuffed and belt-shackled and driven 180 miles to Lima State Hospital for the Criminally Insane. He had no time to say goodbye to anyone except Caul. The abrupt departure marked a decisive shift from treatment in Athens to confinement in a more restrictive institution.

The public controversy surrounding Milligan’s care also accompanied a change in Ohio law. Ohio Senate Bill 297, effective May 20, 1980, gave county prosecutors the right to demand a hearing before a person found not guilty by reason of insanity could move to a less restrictive environment. Reviews, previously held every ninety days, would take place every 180 days and could be open to the public, press, and television. Prosecutor Bernie Yavitch said the drafting group was responding to the outcry over the Milligan situation, and Judge Flowers later told Keyes that the law had passed because of Billy. The law’s provisions reached beyond the Athens case, but the controversy over Milligan’s treatment made the institution a conspicuous part of the debate that produced them.

The Institution as a Measure of What Was Lost

After later transfers, Athens remained the treatment setting Milligan hoped to regain. At Dayton Forensic Center, he told Keyes that he looked forward to his 180-day hearing and hoped Judge Flowers would send him back to Athens. He believed Caul could treat him, bring about fusion, and restore the Teacher. That hope gives the institution a meaning beyond its location: it represented a therapeutic relationship and a possibility of recovery that Milligan contrasted with the more restrictive settings in which he was subsequently held.

The account does not present Athens as free of conflict or constraint. Its staff imposed extensive restrictions, and its open-leave arrangements became the subject of intense criticism. Yet the contrast between Caul’s treatment program and the later security settings remains central. Athens is where treatment, personal liberty, institutional limits, and public judgment met—and where the attempt to care for Milligan became a public and political controversy.