The Minds of Billy Milligan

Nonfiction | Biography | Adult | Published in 1981

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Summary

Background

Chapter Summaries & Analyses

Preface-Book 1, Chapter 2

Book 1, Chapters 3-6

Book 2, Chapters 7-13

Book 2, Chapters 14-19

Book 3-Afterword

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

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Discussion Questions

Themes

The Complexities and Controversies Surrounding Dissociative Identity Disorder

Content Warning: This section discusses the effects of trauma and abuse as well as institutionalization and mental health treatment.

The Minds of Billy Milligan centers on the landmark case of William Stanley Milligan, the first person declared not guilty by reason of insanity because of dissociative identity disorder (DID). While the case undeniably set legal precedent and influenced legislation in multiple ways, Milligan’s story is equally important in the field of psychology given the characteristics of the mental illness he experienced.

Milligan’s case brought attention to and increased awareness of an illness that, at the time, was poorly understood. During Milligan’s childhood, “multiple personality disorder” was not even classified as a disorder in the Diagnostic and Statistical Manual (DSM), second edition; symptoms like what Milligan experienced were instead diagnosed as “hysterical neurosis, dissociative type” (Diagnostic and Statistical Manual of Mental Disorders, Second Edition). Nevertheless, Milligan was misdiagnosed as a teen; furthermore, mental health professionals ignored and invalidated his supposedly accurate diagnosis on multiple occasions as an adult. Milligan received the diagnosis of “multiple personality disorder” for the first time after his arrest, when the disorder was making its way into the third edition of the DSM. Despite this, at the Lima facility, Dr. Lindner changed Milligan’s diagnosis, largely on the basis that Dr. Lindner did not consider the existence of the illness valid.

These misdiagnoses were undoubtedly a result of the lack of information and awareness about the illness. In the years since Milligan’s case, the understanding of the illness has changed and evolved, even earning it a new, more accurate nomenclature (DID), based on an improved understanding of the alters within an individual’s system as not different personalities but fragments or expressions of different aspects of the same personality (“Dissociative Identity Disorder”). This is evident even across Milligan’s experiences, such as when the Teacher begins to fuse and display characteristics of all the different alters, both positive and negative.

Even earlier than this, Turner’s psychological testing of Milligan displayed different IQ scores and behavioral characteristics across the various alters. However, the test results also consistently displayed “evidence of a feminine identity and of a strong superego, which anger threatened to override” (70), across them all. This underlying unity in personality despite the fragmentation of self into different alters is one of the largest factors that contributes to questions regarding criminal responsibility, which connects to the theme of Understanding Self, Identity, and Social Responsibility as well.

While mental health professionals better understand DID today, and it is still classified as a mental disorder in the DSM, the illness remains controversial. Following Milligan’s case, which coincided with the introduction of “multiple personality disorder” in the DSM, the number of reported cases of DID rose in the 1980s. However, in the 1990s, discoveries in several cases revealed that the existence of alters resulted from false memories that therapists planted in patients’ minds (Pierre, Joe. “The Debate over Whether Dissociative Identity Disorder Is ‘Real.’” Psychology Today, 2023). This led to intense criticism and skepticism regarding the validity of the illness. The disillusionment further intensified following an exposé on Sybil and Dr. Cornelia Wilbur, which suggested that the parent, the doctor, and the author of the book on Sybil had fabricated the entire story (Tavris, Carol. “Book Review: Sybil Exposed.” The Wall Street Journal, 2011). Evidence was unearthed in the form of a letter penned by Sybil herself, confessing to the fabrication (Neary, Lynn. “Real ‘Sybil’ Admits Multiple Personalities Were Fake.” NPR, 2011).

Nevertheless, “multiple personality disorder” remained a designated illness in the fourth edition of the DSM in 1994, under the term “dissociative identity disorder.” Experts in the field continued to posit that although some individuals “faked” the illness, others experienced it and the consequences of its characteristic dissociative symptoms. The mind creates alternate identities in response to individuals experiencing traumatic experiences that are so painful to bear that they dissociate from those experiences and perceive them as occurring to other people; thus, mental health experts continue to perceive DID as a mental disorder resulting from a reaction to trauma and is further shaped by sociocultural factors (Pierre). However, the question remains regarding who, ultimately, gives the different alters their names and biographies.

Understanding the Self, Identity, and Social Responsibility

At first glance, Milligan’s story is spectacular but unrelatable. The Minds of Billy Milligan documents the story of a man who experiences trauma and later commits horrific crimes but is declared not guilty because of a specific mental illness. However, since society perceived Milligan’s verdict and subsequent treatment in a certain way, in concert with the text’s recounting of Milligan’s memories and experiences, his story poses fundamental questions about the definition of the individual self and its social responsibility.

The first part of this question aims to understand the illness itself and is rooted in the psychological aspects of Milligan’s story. Even though DID as an illness is better understood since Milligan’s time, it still generates significant controversy and presents many complexities (as explored in another theme, The Complexities and Controversies Surrounding Dissociative Identity Disorder). However, a significant number of mental health professionals agree on one thing, as evident in the disorder’s retention in the DSM under its current name: An individual experiencing the illness does not have multiple different personalities with separate, exclusive characteristics. Rather, the alters are expressions of different aspects of a single personality.

The concept of having one core self, the facets of which are enacted in different identities in different situations across one’s life, is not an alien one even for those without the illness. A woman may have the identities of mother, wife, daughter, or sister in different situations and relationships throughout her life. She may be a patient and accepting mother but a harshly critical and judgmental wife. These seemingly different presentations do not represent multiple personalities, even if the traits appear mutually exclusive by themselves. This was true in Milligan’s case, but to a more intense and debilitating degree: Coexisting within him were the intelligent and insightful Arthur; the brutish Ragen, who had a capacity for violence; the innocent Christene; and the antisocial and criminally minded Phillip.

A related question pertains to the legal aspects of Milligan’s story. In a democratic society, social responsibility relates to the balance between fundamental rights and duties. One has the right to certain things in society, but those rights can be revoked if one does not uphold expected duties (such as paying taxes) or impinges on another individual’s rights (such as harming, stealing from, or defaming someone else). Such actions can result in the revocation one one’s right to freedom, often through imprisonment. However, holding an individual who lacks a unified sense of self accountable or responsible is a more complex matter. The distinction between a person enacting different identities in different scenarios, and a person experiencing dissociative identities (like Billy Milligan) is that the latter clearly lacks an awareness of self because of the dissociative separation among identities. This presents the possibility of the insanity plea, which Milligan’s lawyers used successfully. However, Milligan’s verdict didn’t necessarily negate the question of culpability, i.e., whether he was responsible for the crime in question. Both the prosecution and defense agreed that Milligan committed the crimes. Additionally, although Billy, the core self, had no memory of these events, all the alters involved in the crimes (Ragen, Adalana, Phillip, and Kevin) not only knew exactly what they were doing but also were aware of the criminality of their actions and carried them out with intention.

Eventually, the fused Billy, in the form of the Teacher, recalled these incidents and the motivations behind them. However, whether it would be fair to hold Milligan responsible retroactively is another question. Milligan’s progress and healing was not straightforward, as evident in the regressions he experienced, including defusing on multiple occasions. Thus, the question is whether individuals who are not entirely and reliably capable of taking responsibility for their unified self should be granted freedoms or punishment in accordance with individuals who are capable of doing so. In this way, Milligan’s story points to questions about social responsibility in the context of the individual self and multiple identities.

The Intersection of Psychology, Media, and the Law

Milligan’s case is considered a landmark event in the history of US law. It holds similar importance in the field of psychology because of Milligan’s illness. The case represented an intersection of these fields at the time; however, a third aspect that significantly contributed to how Milligan’s story played out following his verdict was the media.

As already established, Milligan’s case set legal precedent because it was the first to result in a verdict of not guilty by reason of insanity because of DID. However, this led to much backlash and public outrage in society, especially because of the perception that Milligan was allowed to shirk criminal responsibility. The news surrounding Milligan greatly precipitated this feeling, especially when publications began running reports of his unsupervised furloughs into town. Anxiety and alarm regarding public safety pushed legislative change, which resulted in the passage of the “Milligan law.” Legislators confirmed that this law was passed in response to public unrest; societal response to Milligan’s verdict ensured that US courts began to deny pleas of not guilty by reason of insanity (NGRI) based on DID in future cases (See: Background).

In addition to legal technicalities, such as the burden of proof of sanity resting on the prosecution, what largely influenced Milligan’s receiving a not guilty verdict was the lack of information at the time about the disorder. Dr. Wilbur, the physician who treated Sybil, a woman with 16 alters, was then considered an expert on the illness. Significantly, however, Dr. Wilbur and Sybil were both accused of fabricating Sybil’s entire story (Tavris). Nevertheless, at the time of Milligan’s case, the lack of experts and information on the illness meant not only that Dr. Wilbur’s testimony weighed heavily in court but also that her recommendations influenced the therapeutic approach that Dr. Harding adopted at Harding Hospital.

In yet another intersection of psychology, the law, and media, the reporting of Milligan’s case and treatment and the subsequent influence that this had on legislation significantly impacted Milligan’s progress and healing. The negative publicity that Milligan, Dr. Caul, and Athens received greatly affected Milligan’s mental health, intensifying his anxiety and leading to episodes of regression and defusing. These episodes, in turn, eventually resulted in Milligan’s being moved to maximum-security institutions for a time, which greatly hampered the progress he had been making given that he reportedly received inadequate care.

The interaction between the media and the fields of psychology and law in Milligan’s case was ultimately somewhat circular. The legal precedent that Milligan’s case set, as well as the unique, psychological aspects of the illness, generated intense interest. The media interest, in turn, influenced changes in legislation and impacted Milligan’s therapeutic journey. However, while the book portrays the effect of the media attention on Milligan as wholly negative, the same attention arguably afforded Milligan the opportunity to share his narrative, as evident in the existence of this book.