Revisiting Milligan

By Rachael Beardsley

Although more than 40 years have passed, Dr. David Malawista still remembers caring for one of The Ridges’ most infamous patients. He remembers the chaos of media attention that often got in the way of treatments. He remembers the wild hospital environment, full of people seeking fame and attention rather than caring for the mentally ill.

And, he remembers the man who was at the center of it all.

Billy Milligan isn’t someone you forget.

In December 1978, people across the state were focused on the Athens Mental Health Center. Its newest patient, William “Billy” Milligan, had recently made history as the first person to successfully use multiple personality disorder as an insanity defense. As soon as his trial ended, he was taken to Athens and settled down for the night in a small room overlooking Ohio University. Milligan, a man some people saw as soft-spoken, frightened and abused, had just been tried for raping three women at Ohio State University. Though Milligan had committed the crimes, he was sent to a mental health facility rather than a prison when his severe mental illness became apparent.

Milligan was diagnosed with multiple personalities, a condition now called dissociative identity disorder. Many people were sympathetic to his condition, but the outrageous claims were causing others to question if he was fooling everyone, especially his doctors in Athens.

“A group of the staff [at the Athens Mental Health Center] was sort of pro-multiple personalities, and some of us remained skeptics throughout the whole thing,” said Malawista, senior staff psychologist at the hospital during the time Milligan was treated. “I think he was putting a lot of it on. Billy was smart, he was a bright guy, which made him more difficult to deal with and more dangerous.”

Milligan’s transfer to the Athens Mental Health Center came with many added difficulties. Journalists wrote scathing articles criticizing the ruling in the case, and many accused Milligan’s attending physician, Dr. David Caul, of giving him special treatment. Community members were concerned for their safety, and Milligan’s erratic behavior—arguing between his different personalities, resisting treatment and trying to sue his doctors and lawyers— escalated the tension.

And, in the middle of it all was an OU professor.

Daniel Keyes, who taught creative writing at OU, began to visit Milligan regularly. He was interviewing Milligan for a book he planned to write about Milligan's life. Keyes, who had already been nationally recognized for his book Flowers for Algernon, was looking for his next big story.

“Having someone like Daniel Keyes come in, and so often, was very out of the ordinary,” Malawista says.

Keyes interviewed Milligan over the course of many weeks, and he witnessed Milligan’s transformation as his doctors coaxed him into “fusing” his many personalities. The fused Milligan claimed to have “almost total recall” of all his memories. This allowed Keyes to create a vivid biography of Milligan’s life.

Keyes soon discovered the long, chaotic path that led Milligan to Athens. Milligan’s life was filled with instances of tragedy, abuse and criminal activity.

Milligan said one of his stepfathers emotionally, physically and sexually abused him during his adolescence, a claim his mother and brother supported. Current understanding of dissociative identity disorder states the illness often arises after severe childhood trauma, like those Milligan described to Keyes. Malawista says it is a coping mechanism to deal with the pain.

“The notion is, there is something going on in this person’s life … that is so psychologically untenable, I can’t look at it; I can’t think about it; I can’t deal with it,” Malawista says. “So I literally split off a piece of my personality and develop a piece of my personality to manage that particular element of my life.”

As Milligan grew up, his mental health problems manifested in startling ways. Keyes writes that Milligan frequently “lost time” as he switched between personalities, waking up at home, in the middle of class or in a different state with no idea how he got there.

Milligan spent time in Columbus State Hospital and was discharged to outpatient care for being disruptive. After being expelled from high school for his involvement in a bomb threat, he joined the Navy, but was discharged for erratic and unruly behavior.

In 1972, Milligan spent time in a Zanesville detention camp for teenage boys after being convicted of rape, though he said it was a false accusation. After he was released, he claimed he worked as a security guard for a drug dealer. He was arrested again in 1975 for robbing a drugstore in Lancaster, Ohio, and paroled in 1977. Six months later, he was arrested in Columbus after being identified in a photo lineup as the Ohio State rapist.

Milligan’s attorneys referred him to court-appointed psychologists after noticing his strange behavior. They even invited Dr. Cornelia Wilbur, known for having treated another patient with multiple personalities, to observe Milligan and give her diagnosis. Wilbur concurred with Milligan’s previous diagnosis, as she too believed he had multiple personalities.

Based on those findings, a judge ruled that Milligan was incompetent to stand trial. He was transferred to Harding Hospital in Worthington, Ohio, for treatment. Not all of the hospital staff believed Milligan’s diagnosis, and they reported that he threatened them with the appearance of his violent personality, known as Ragen, to get more privileges.

After seven months at Harding Hospital, Milligan was found competent to stand trial and was transferred back to the Franklin County Jail. Doctors thought Milligan’s 10 known personalities had been fused together. Days before the trial, however, Milligan revealed the treatment had not been successful and he was still living with multiple personalities.

A judge agreed that Milligan needed further treatment rather than jail time. People committed to the mental health system by Ohio courts were often sent to Lima State Hospital for the Criminally Insane, a place notorious for rough treatment and poor care. Milligan’s doctors and lawyers feared he would be worse off in Lima, so they began to look for an alternative hospital. They then found Caul at the Athens Mental Health Center.

As the medical director of the hospital, Caul had treated other multiple personality patients, but never one like Milligan. The media attention surrounding his treatment was unusual. At every turn, Caul was accused of being too lenient on a man who raped three women. Caul, however, was never quiet about his intentions.

“If he comes to Athens, I want to be able to treat him in the same manner that I’ve treated other multiples, in an open—and the most therapeutic—setting we have,” Caul is quoted in Keyes’ book. “And if I can’t do that, don’t send him.”

The open setting at the Athens Mental Health Center involved freedom to roam within the hospital and, as treatment progressed, freedom to walk on the hospital grounds and to visit the town unsupervised. Many community members were uncomfortable with Milligan having such privileges, especially considering his proximity to the OU campus. Caul even trained him on what to do if people harassed him in town, but Milligan reported that the people he met, including many OU students, treated him with respect and sympathy.

Milligan was full of more surprises. During the first weeks of treatment, he revealed to Caul that he had more than his 10 known personalities. In reality, Milligan claimed to have 24 distinct personalities of varying gender, age and ethnicity.

Arthur, for example, was the personality that dominated in safe spaces, where he often directed the others in a haughty British accent. Ragen dominated in dangerous places, knew martial arts, and often spoke in a thick Slavic accent. Other personalities included Tommy, an escape artist who once escaped a straightjacket in prison, and David, one of the child alter egos that came out whenever Milligan was in pain.

It was clear to Caul and the rest of his team that Milligan would be a difficult case. His severe illness combined with media attention made it difficult for doctors to create a stable environment at the hospital. It was almost impossible for Milligan to make progress in his recovery.

“It was a zoo around multiple personalities at the time,” Malawista says. “It was clear the bright spotlight was on Billy.”

Milligan seemed to create many barriers to his own treatment. Malawista says Milligan was involved in drug distribution in the hospital and took advantage of vulnerable female patients. He also had an affair with one of the nurses, who later left the hospital.

“Billy was a very difficult individual on a good day,” Malawista says. “He was very manipulative. He was engaged in really problematic behavior regularly on the ward.”

Milligan also received special privileges that led many to question Caul’s motives. Milligan regularly painted and sold artwork—work which Malawista describes as “mediocre”—to the public for thousands of dollars. While other patients were only allowed to keep a small amount of money on the ward, Milligan kept all the money he earned; he even bought a car.

“No other patient was allowed to walk around with more than $20,” Malawista says. “All other money had to be in our financial office. Billy would walk around with wads of cash.”

As Caul became focused on Milligan, staff began to demand he spend equal time with his other patients. But Caul was interested in creating a multiple personality clinic with Milligan as his star patient. He wanted to bring more attention to the hospital and to himself.

“I think he saw an opportunity to be famous and to be portrayed in a movie and to have considerable stature,” Malawista says.

When Milligan was first transferred to the Athens Mental Health Center, there was conflict over who would get the rights to his story for a movie or book adaptation. Milligan chose to work with Keyes in part because Caul endorsed him—the two were friends. Malawista says that Keyes might have hoped to capture some of Milligan’s spotlight.

“It became a business transaction,” Malawista says. “[Keyes] was looking at Billy’s case, and after [his last book], he was not a prolific writer of hits, and he saw Billy as star quality.”

Eventually, the media scrutiny caused Caul to remove many of the freedoms he had given Milligan, and Milligan went into a downward spiral. His outbursts became too much for the Athens hospital, and he was transferred to Lima.

He stayed in state custody, bouncing between different hospitals. He returned to Athens once more and was involved in a shooting at the house of a hospital staff member. In 1986, he escaped from the Central Ohio Psychiatric Hospital and was on the run for several months before his arrest in Miami. He was discharged in 1988 and released from all state supervision in 1991.

“After he left the hospital and everybody sort of washed their hands of him, he kept getting into trouble in various locations and then dropped off the radar,” Malawista says.

Though Caul succeeded in fusing Milligan’s personalities in Athens, Milligan never amounted to much. He agreed to pay back the costs of his stays in Ohio hospitals, an amount that totaled about $450,000. He never paid the full amount and filed for bankruptcy while living in California. Eventually, he moved back to Ohio.

“Billy is integrated, he’s healed, or whatever, so what does he do?” Malawista says. “He does nothing with his life other than get in trouble down the line.”

Milligan died of cancer in an Ohio nursing home in 2014. He was 59.

Keyes also died in 2014, six months before Milligan. Caul died over 25 years earlier. Most of the key figures in this story are gone, yet many people haven’t forgotten Milligan.

But, the key question surrounding Milligan was never answered. Was he truly an abused and ill man or did he trick his doctors in order to avoid jail time?

“There was a lot of stuff swirling around Billy, and not just Billy, but the notion of multiple personalities,” Malawista says. “Everyone was looking for it, everybody wanted a patient who was multiple personality.”

Malawista says there was and still is debate about whether multiple personalities are real. It is, in his opinion, a very rare diagnosis.

“The notion that you have multiple personalities works better for me if there are [fewer personalities],” he says. “Why do you need all of these fragmented pieces? A couple I understand, but once you get beyond three, four, five? I don’t know.”

Malawista says he confronted Caul about Milligan’s behavior one day, and Caul dismissed him, saying Malawista didn’t believe in multiple personalities.

“I said OK, let’s grant that he’s a multiple personality, but as you’re integrating these personalities more and more, what we see is an antisocial, and we’re back to, ‘Here’s a guy that committed multiple rapes,’” he says. “[Milligan] was very good at drawing people in and then using them, which is a hallmark of psychopaths.”

Gail Fisher, a former OU graduate student and part-time photojournalist for the Athens Messenger at the time, had the opportunity to photograph Milligan during an interview organized by Caul. She says she didn’t notice anything out of the ordinary, though Caul claimed he had persuaded Milligan to switch personalities for the journalists.

“I spent such a short time with him that I wanted to see some kind of physical change, … but I don’t remember that happening except for maybe a difference in his pitch of voice at some point,” Fisher says. “I remember him being dour, very somber, gloomy. I remember leaving the situation feeling I had not captured anything beyond an expressionless person sitting in a darkened room.”

Milligan is painted in an extremely sympathetic light in Keyes’ book “The Minds of Billy Milligan.” It helped create Milligan’s public image as a tortured and abused soul. But some who were directly involved in his treatment, like Malawista, never completely bought into the image.

“He was treated really differently, and I think to the detriment of accurately seeing what was going on with him,” Malawista says.