David Caul

David Caul’s role in Billy Milligan’s story is defined by a practical and clinical commitment to treatment: he allows Milligan a carefully arranged furlough when fear has made hospital life difficult, states firm minimum standards for treating multiple personality, and later accepts responsibility for rebuilding care after Milligan’s return to Athens. His actions unfold within a system where clinical judgment and court-ordered restrictions are closely linked, but are not the same decision.

Clinical Role and Institutional Context

Caul is involved in Milligan’s treatment at Athens Mental Health Center, where the possibility of care outside the hospital remains conditioned by Milligan’s safety and the institution’s rules. His place in the narrative becomes especially clear in two episodes: the September 1979 furlough to the Hocking Valley Motor Lodge, and the later effort to bring Milligan back to Athens after a prolonged period in maximum-security hospitals.

The legal setting matters to Caul’s work. On December 10, 1979, a court found that Milligan had a mental illness diagnosed as multiple personality and was subject to hospitalization, citing risks to himself and others as well as his need for treatment. That ruling established the basis for continued hospital care; it did not, by itself, determine what treatment should look like. Caul’s testimony and subsequent work address that clinical question while accepting that the court may impose limits.

The Nelsonville Furlough

On September 18, after Milligan returned from Lancaster agitated and fearful that he might be shot again, Caul allowed him a furlough. Milligan also feared that his sister’s house could be a target, so the arrangement was for him to stay at the Hocking Valley Motor Lodge in nearby Nelsonville. He took his easel, paints, and canvas, with the intention of working undisturbed. The permission was a measured response to distress, not an unrestricted release: the place to stay had been agreed upon, and the expectation was that he would use the time to paint.

The attempt at quiet did not hold. Milligan checked in under a false name, but became too tense to relax. While painting, he heard voices and searched the room and hall before concluding that the sounds were coming from within his own mind. He identified them as the voices of the undesirables rather than Arthur or Ragen, whose accents he believed he would recognize. He could not work or sleep, and was afraid to return either to his sister’s home or to Athens. The episode shows the limits of what a change of setting could accomplish when his symptoms intensified.

On Wednesday, Milligan called Mike Rupe and asked him to come to the motel. Seeing Milligan’s nervousness, Rupe contacted Caul. Caul instructed Rupe to stay with him that night and bring him back the next day. With Rupe present, Milligan relaxed enough to talk about his hopes for treatment. He proposed a short hospital stay until Dr. Cornelia Wilbur judged that he could live alone in an apartment, followed by treatment under her guidelines. He believed he could still function despite his current difficulties. Caul’s response at the crisis point was concrete: arrange company for the night and a return to care the following day.

Treatment Principles

Caul’s views on clinical practice are set out during a deposition about the requirements for treating a person diagnosed with multiple personality. He described treatment as work for a mental-health professional, preferably a psychiatrist, and emphasized that the clinician must accept the condition rather than approach it from disbelief. The point is not simply that a diagnosis has been assigned; treatment, in his account, depends on a practitioner being willing to engage with the condition as real.

He also argued against antipsychotic medication, saying that it could contribute to fragmentation and other effects detrimental to treatment. When counsel suggested that Caul had described ideal rather than essential conditions, Caul rejected that interpretation: he regarded the criteria under discussion as minimal, not optimal, and maintained that without such a foundation a practitioner should leave the patient untreated. The exchange gives his clinical position unusual force. He does not present the standards as a best-case refinement, but as a threshold for responsible care.

These principles take on added weight in the circumstances of Milligan’s treatment. Caul’s emphasis on acceptance and caution about medication sits against a history of disrupted care and a patient whose internal communication has become difficult or absent. His testimony describes what he believes competent treatment requires; it does not establish that Milligan’s later recovery will be straightforward or that every stated condition can immediately be met.

Return to Athens and Continuing Work

In the later court proceedings, Caul testified that he would accept Milligan for treatment and abide by any restrictions the court imposed. On April 8, 1982, Judge Jay Flowers ordered Milligan’s transfer back to Athens Mental Health Center. The order permitted painting and woodworking, while calling for close supervision away from the ward and requiring court notification before Milligan could leave the hospital grounds. Caul’s willingness to work within those conditions connected his clinical role to a cautious plan for renewed treatment; the transfer itself was the judge’s decision.

Milligan returned to Athens on April 15, after two and a half years in three Ohio maximum-security hospitals. By then, there had been no co-consciousness among the personalities for a long time. Allen could hear voices with British and Yugoslav accents, but neither he nor Tommy could reach them or communicate with each other; much time was lost, and the Teacher had not returned. Tommy painted landscapes, Danny still lifes, and Allen portraits while also recording their experiences at Lima, Dayton, and Columbus. The personalities’ different activities offered visible points of continuity, but did not resolve the deeper disconnection.

Caul began the difficult task of undoing the damage of those two and a half years and trying to put the pieces back together. The account gives no timetable for that work and does not promise a successful outcome. Its significance lies instead in the contrast between Milligan’s return to a treatment setting and the condition in which he arrived: access to familiar forms of care had been restored, but internal communication remained broken and the Teacher was still absent. Caul’s work begins in that gap between institutional return and psychological repair.