Harding Hospital Policy of Acknowledging and Discussing Personalities

Harding Hospital’s policy of acknowledging and discussing personalities took shape through a reversal in the treatment of William Stanley Milligan. Staff first tried to contain the effects of the identities he reported by insisting that everyone address him as Billy; after Dr. George Harding reconsidered that approach with Dr. Cornelia Wilbur, the hospital instead allowed those identities to be named and explored in therapy. The change did not mean abandoning responsibility or clinical structure. It marked a dispute over whether suppressing the personalities could help Milligan integrate, or whether it pushed them out of sight and made treatment less effective.

Setting and Initial Approach

When Milligan arrived at Harding Hospital on March 16, he was taken with Judy Stevenson and Dorothy Turner to Wakefield Cottage, a locked unit for fourteen difficult patients requiring constant observation and personal attention. He was placed in a special-care room with a peephole in its heavy oak door. The hospital had assembled a therapy team, and Turner wanted staff to see the reported multiple-personality syndrome directly. The immediate question was not only how to treat Milligan but how the staff should respond when different identities appeared.

The problem was sharpened by the identities’ secrecy. Allen explained that the people around Milligan knew only Billy Milligan, and that all the personalities answered to Billy’s name so the secret would not get out. In the hospital, however, staff encountered shifting names and conduct that Milligan might later deny. Some workers found it difficult to manage an individual who said that someone else had acted when they believed they had witnessed the act. They also worried that his references to Ragen could be understood as threats and that his movement between staff members was disrupting treatment on the unit.

Dr. Harding’s first policy response was to keep discussion of the alternate personalities within therapy sessions. Staff were instructed not to mention or discuss the other names on the unit, particularly in front of other patients. A nursing-goal sheet dated March 28 made the immediate aim explicit: Milligan was to accept responsibility for acts he denied, with progress measured by the absence of denials. If he denied playing the piano, staff were to state matter-of-factly that they had seen or heard him play. If he disowned notes he had written, they were to tell him they had seen him write them. If he referred to himself as another personality, they were to remind him that his name was Billy.

This approach separated the behavior staff could observe from Milligan’s explanation of who had performed it. Its practical purpose was to avoid reinforcing a succession of names in a unit where other patients might be confused, while still addressing conduct and responsibility. But it also made the naming of identities itself something to be corrected in ordinary interactions. The policy treated recognition as potentially disruptive and reserved the personalities for the controlled setting of therapy.

Reversal Toward Recognition

The hospital changed course after Dr. Harding consulted Dr. Wilbur. He called a team meeting at Wakefield Cottage and told staff that refusing to recognize the alternate personalities had proved counter-therapeutic. The earlier hope had been that ignoring them might bring about integration. In his revised assessment, the opposite had happened: the personalities had gone underground. He maintained that Milligan still needed to develop responsibility and accountability, but argued that treatment should avoid repressing the identities.

The reason was also tied to the case’s legal future. If Milligan was to achieve fusion and stand trial, Dr. Harding concluded, the personalities had to be recognized and dealt with as individuals. Recognition was therefore not presented as an alternative to integration; it became part of the proposed route toward it. Nor did the change erase the hospital’s concern about the effects of behavior on others. It revised the method: staff could acknowledge the identities without treating every action as exempt from discussion or responsibility.

A new nursing-goal sheet, entered by Donna Egar on May 12, translated that revision into practice. Its goal was for Milligan to feel free to refer to other personalities so that he could discuss feelings he otherwise found difficult to express. The proposed evidence of progress was frank discussion with staff. The instructions now told staff not to deny that he experienced dissociations and, when he believed he was another personality, to elicit his feelings in that situation. Where the March plan corrected the name and returned him to Billy, the May plan used the identity he reported as an opening for conversation.

Practice and Therapeutic Purpose

The difference between the plans was procedural as well as conceptual. Under the first, staff were to answer a reference to another personality by reminding Milligan that his name was Billy. Under the second, they were to take the reported experience seriously enough to ask about the feelings associated with it. The new approach sought information and communication that the former practice risked foreclosing. It also made staff response part of the treatment: neither reflexive denial nor unstructured acceptance, but discussion within a therapeutic relationship.

The change mattered for the expression of feelings that Milligan found hard to voice directly. Rosalie Drake later felt relieved that the personalities could be discussed openly; she had already found herself responding to them, especially Danny. The revised policy thus aligned formal practice more closely with interactions that some staff had already found difficult to avoid. Instead of requiring staff to act as if the personalities did not exist, it gave them a stated clinical purpose for engaging with them.

The garden work offers a concrete example of the distinction between naming an identity and addressing its emotional response. In mid-May, Drake and Nick Cicco discovered that Danny was terrified of a hand-run Rototiller. They used a gradual deconditioning program, asking him to approach the machine progressively. When Cicco suggested that Danny might eventually operate it, Danny nearly fainted. The episode shows staff working with the fear as Danny’s reported experience, rather than answering the appearance of that identity by insisting only on Billy’s name. It does not establish that every aspect of the policy succeeded, but it illustrates the kind of specific feeling the new plan made discussable.

Institutional Limits and Significance

The recognition policy developed amid legal and public pressures that made Milligan’s diagnosis consequential beyond treatment. Before the story became public in September 1978, the diagnosis was known to those treating him, prosecutors, and the judge; the public defenders wanted it kept secret because publicity could complicate both treatment and trial. In that setting, the hospital’s practice of discussing personalities was not simply a matter of vocabulary. It concerned how Milligan’s condition could be understood and handled while the case remained pending.

Later institutional restrictions should be distinguished from Harding Hospital’s revised policy. At Athens, after Dr. Wilbur recommended that Milligan remain there, staff conflict and concern about publicity led to a restrictive contract governing calls, visitors, money, painting supplies, and contact with other patients. He was eventually transferred in restraints to Lima State Hospital. A later court finding described his condition as multiple personality and ordered hospitalization consistent with that diagnosis. These developments show that acknowledgment of the diagnosis did not guarantee freedom of movement or a consistent treatment environment; recognition could coexist with stringent control.

The policy’s central tension was therefore never simply whether staff should use one name or several. The two approaches embodied different judgments about what might help: the first sought accountability by redirecting Milligan to a single public identity, while the revised plan treated discussion of his other identities as a means of reaching feelings otherwise difficult to express. Dr. Harding’s reversal made that tension explicit. It preserved the demand to address conduct while changing the terms on which Milligan’s reported inner experience could enter treatment.