Central State Hospital (CSH), Milledgeville, Georgia
Central State Hospital in Milledgeville, GA – the tragic and heroic true story of one of the largest mental institutions in the United States. Written by Craig Dominey.
“You best behave yourself or I’m sending you to Milledgeville!”
If you are a Georgia native of a certain age, a scolding like this from your parents would make your blood run cold. You knew they weren’t talking about the charming, former state capital of Georgia with its grand antebellum homes and buildings, towering oak trees and vibrant universities. They were talking about the sprawling, ominous institution just a couple of miles up the road, these days officially known as Central State Hospital, once one of the largest mental hospitals in the United States.
Driving around the largely empty and decrepit campus there is an eerie calm that belies its often chaotic past, when it was overrun with patients committed for all manner of mental afflictions, rightly or wrongly. On the front side of campus, once-majestic buildings of Gothic-like architecture sit decaying on the edges of a shady pecan grove, their roofs rotted and collapsed in spots, paint peeling off the moldy walls, thick vines snaking into shattered windows. On the back side, more institutional-looking brick buildings dot the rolling hillsides which once were farmed by patients both as treatment and servitude. Acres af empty fields are thought to hold the remains of thousands of unidentified patients, many forever lost.
Many believe Central State Hospital is haunted – not by one particular ghost or horrific event, but a compounding of many years of suffering. But while ghost hunters and fans of the macabre may flock to its buildings, the real story of Central State Hospital is also one of good intentions and heroism, and serves as a mirror of this country’s changing attitudes toward the mentally afflicted.
Up until the early 19th century, mental illness was a misunderstood disease. Many felt lunacy was the result of demonic possession, with punishment by God or man the only treatment. People diagnosed (or misdiagnosed) as lunatics were often thrown in prison, shunned in communities, farmed out as virtual slaves or simply the dirty secret best kept at home.
These attitudes were beginning to change in the United States in 1834 when Georgia governor Wilson Lumpkin, addressing public concern for the plight of those afflicted, fought for state care of the “idiots, lunatics and insane.” With approval of the Georgia House and Senate, a lunacy commission was created. Among the first commission members were an influential group of physicians from Milledgeville, then the state capitol and the epicenter of wealth and power. Riding through Milledgeville at the time, it would be common to find the streets lined with cotton bales from surrounding farms, waiting for shipment downriver to the Georgia port of Darien on the Atlantic Ocean.
The Milledgeville physicians influenced the state legislature to authorize the creation of a “State Lunatic, Idiot, and Epileptic Asylum” on December 28, 1837, the first institution of its kind to treat all three afflictions. A 40 acre plot of land two miles south of Milledgeville was purchased for $4000, due to its proximity to the capitol and the physicians’ practices, plus its centralized location in the state. Five years later, the Governor placed the hospital in control of trustees and appointed its first superintendent, Dr. David Cooper. These trustees were only reimbursed for their everyday expenses, as it was felt that small salaries would not attract a high calibre of physician. Trustees could look upon hospital work as a public service, meaning physicians like Dr. Cooper could also carry on their private practices in Milledgeville while overseeing the institution.
The first buildings were typical brick structures with wood roofs, 3-4 floors each. Each floor had around 20 rooms with glass windows and cast iron fixed window sashes, opening into an airy hallway. The buildings were lit by lamps and torches. Men lived in the first two floors, women in the top floors and supervised by a matron. Slave attendants and servants lived in the basement next to the large iron stove that heated the building. Eight staff members managed he entire institution.
The first patients came with a variety of mental disorders, from hallucinations brought about by religious fervor to paranoia, depression and alcoholism. Georgia residents deemed lunatics, idiots or epileptics had to first stand trial before a jury that would include at least one physician. If found to be a danger to the community, a legal record was made and they would be sent away to the hospital in chains. Patients needing calming were put in special blue-colored rooms – and if the soothing color wasn’t enough, they were chained to a chair in the corner to make sure.
Dr. Cooper applied the then-radical model of the “institution as family,” feeling that patients were best treated by an extended family of strangers rather than at home where their conditions were misunderstood, or emotional attachments would keep them from being cured. Rather than being locked up in cells, patients were encouraged to work in the garden, field or workshop and gain a sense of usefulness.
Another prominent Milledgeville physician named Dr. Thomas A Green was selected to be the second superintendent in 1845, and he built upon the “institution as family” model. New patients would frequently arrive at the institution in horrible condition – beaten, filthy and in shackles. Dr. Green made it a personal ritual to release these shackles as soon as the patients arrived, essentially giving them a new level of freedom within the institution. He regularly ate with staff and patients, and abolished further physical restraints. Of the 200 patients admitted, only a small number had to be kept in isolation. Even when the institution was starting to become overcrowded, Dr. Green also had a reputation for not turning people away.
From the early days, funding the hospital was a challenge. At first it was believed that the hospital could be partially self-sustaining by admitting pay patients, but this was soon seen as untenable. Dr. Green asked for more state money to complete the hospital, build a library and chapel, and purchase more land. Shortly thereafter, with the Civil War ravaging the state’s cotton economy, families could no longer pay for treatment of their loved ones, raising operational costs and leaving the hospital’s financial fate even more in the hands of the political machine.
By the time Union General William T. Sherman marched through Georgia, destroying nearly everything in his path, the hospital was already in dire straits. Though Sherman spared the hospital, it now had little support from the defeated state. Dr. Green continued to take in refugees from other Southern states where hospitals were in Federal hands. With the able-bodied off to war, older and infirm staff could hardly handle patient care. Supplies were scarce, and Dr. Green resorted to scouring the countryside for food and money, and selling off what little the hospital had for cash.
Another challenge from the South’s defeat was the increasing black patient population freed by the war. Though not as segregated as other institutions, the hospital had no separate buildings for black patients as required by law, leaving them to sleep outside on hospital grounds. In 1866 the first “colored only” building was built on campus, the start of an eventual second campus (which in later years would be repurposed as a state prison).
By 1872, 448 patients were being treated by 4 doctors at the hospital with an annual budget of $100,000. To try to control the population, Dr. Green only admitted non-violent patients and would put 2-3 together in small, 10-12 foot rooms. Dr. Green believed that the earlier patients were treated (1 year or less), the more successful treatment would be and the patients could be returned home. But despite his best efforts, the explosion in new patients was just beginning.
Dr. Theophilus Powell, assistant physician to Dr. Green and a noted scholar of psychiatry, became superintendent in 1874 and immediately inherited the growing issue of patient overcrowding. The asylum had become a dumping ground not just for the truly insane, but for communities looking to get rid of their unwanted (alcoholics, criminals, the elderly) and for those who simply had nowhere else to go. Three years later, a law passed making the asylum free for all state citizens. Part of this reasoning was undoubtedly due to political pressure – legislators were keen on taking care of patients from their home districts, while Milledgeville lawmakers wanted to keep the facility constantly in business for their friends who worked there.
Dr. Powell and his staff developed more accurate methods of diagnosis to try to keep the population manageable. In 1886 a law passed allowing patients to be returned home who were deemed incurable but harmless, to make room for those who could be treated. Dr. Powell also continued the work, exercise and amusement programs for patients. An on-site railroad station and construction of a new hospital building led to a flood of new patient applications.
At the dawn of the 20th century, overcrowding had become a major problem at the facility now renamed the Georgia State Sanitarium. By 1910 there were 3347 patients cared for by 12 physicians. Decrease in care was inevitable, with numerous reports of abuse, neglect, unsanitary facilities and seclusion rooms surfacing. Patients could only expect their basic needs to be taken care of, with staff unable to provide appropriate treatment for their illnesses. Many patients whose mental state was diagnosed as “unclassified” were simply lost in the system, leading to many stories in later years – some true, others just folktales – of loved ones vanishing in the bowels of the sanitarium.
Farm work was still considered a helpful activity for the patients. 800 acres of nearby farmland took care of the facility’s food needs, and were strenuously farmed by the patients. Even though this program offered little in the way of actual treatment, it developed and nurtured job skills that the patients could use back home when discharged.
In 1921 the segregation of black patients came to an end, but racial tension was still a reality in the community at large. Four years later the first reported murder of a staff member at the hands of patients occurred when Amy Oxford, a popular nurse, was struck in back of the head with an axe handle by a black patient, who then returned to work quietly. As news spread, the local townspeople forced their way into the building where the patient was in seclusion and killed him in the same manner.
“Shock treatment makes you forget what you want to remember and remember what you want to forget.”
Georgia State Sanitarium changed its name again in 1929 to Milledgeville State Hospital, a reflection of society’s evolving views toward the mentally ill and treatment. By now the hospital had become a small city, with 6000 patients in treatment (600 per physician) and a waiting list of 1500. Many buildings were deteriorating and had become fire traps. In response, the hospital was expanded to include 132 more acres, four new hospital buildings made of brick and modern interiors were built, plus a dedicated tuberculosis ward.
But poor state financing and draining of able-bodied staff during World War II meant that radical treatment was needed to stem the unrelenting tide of patients.
By the 1940s, Milledgeville State Hospital had over 10,000 patients averaging 20 year residencies. Attendants and nurses worked 60-70 hour weeks, with nurses making around $74 dollars a month. It was estimated at the time that thousands of these patients could have been sent home as harmless. Many patients claimed to have been “railroaded” into the institution by others, for various reasons.
To combat the untenable conditions, more radical forms of treatment such as insulin shock and electroshock therapy (also known as electroconvulsive therapy or ECT) became commonplace. Electroshocks were done on a mass assembly basis and at the discretion of staff. Patients were frequently confused if shocks were being given as treatment or punishment, and afterwards would be walked back to the day room in a stupor. While hospital chaos died down thanks to this treatment, memory loss in patients was common, unpredictable and sometimes permanent – helping wipe out, as some advocates noted, any memories of abuse.
Lobotomies were introduced in 1951 for chronic cases. 125 severely ill patients were given the treatment, of which only 24 were able to return home, with an unknown number becoming even worse.
Atlanta newspapers ran frequent articles on patient abuse and deteriorating hospital conditions, becoming one of the few advocates patients had. As it had been throughout its history, Milledgeville State Hospital continued to be influenced by state politics, with the board pressured by politicians to appoint staff as political favors, and patient levels kept high for economic profit.
In the 1960s the now-renamed Central State Hospital had over 12,000 patients and vied with Pilgrim State Hospital in New York as the largest facility in the country.
“Rows upon rows of numbered, small, rusted markers as far as you can see. No names, just numbers. It must be the most gruesome sight in Georgia. Unknown humans, shunned when living, deprived of their very name in death – and literally known only to God.”
While some patients treated at Central State Hospital eventually returned home, many did not, literally disappearing into the earth. Today what looks like pastoral, rolling fields are actually the secret burial grounds for tens of thousands of patients, many feared to be lost forever.
As far back as 1938, a cemetery for African-American patients was dug up to make room for a new building. Their bodies were disinterred and, with the caskets long disintegrated, placed into small boxes and moved closer together, marked only by simple metal poles with identification numbers. The use of these numbered poles instead of headstones was a common and macabre burial method on hospital grounds. It is believed that around 30,000 patients are buried at Central State Hospital in six neglected cemeteries, making it one of the largest graveyards in the world for people with mental disabilities.
In the 1960s, groundskeepers tossed thousands of these numbered markers into the woods without recording their locations, leaving the graves forever unmarked. Other markers were lost in underbrush, and as memories faded it was no longer clear where the true boundaries of the burial areas were.
In response, groups of volunteers like the Georgia Consumer Council worked to identify as many graves and patients as possible. Some recovered markers were placed in a special memorial. State and national media covered their efforts, and donations began trickling in. To help the fundraising effort, Dr. Peter Cranford, a former clinical psychologist at Central State Hospital, donated the printing rights to his book “But For The Grace of God: The Inside Story of the World’s Largest Insane Asylum,” recognized as the definitive history of the institution.
(Note: While sold on Amazon.com at collector’s prices, this book is also available at Central State Hospital’s museum for around $10 if you happen to visit).
With improved medications, home treatment, construction of new facilities statewide and less stigma toward mental disabilities, the need for a massive and crowded institution like Central State Hospital died away and the population dropped dramatically. As of this writing only 300 patients remain, soon to be reduced to around 180 patients who have been committed by the courts.
Once one of Milledgeville’s top employers, Central State Hospital’s downsizing has been an economic blow to the community. Tasked with finding a use for this 1750-acre campus, the State of Georgia created the Central State Hospital Local Redevelopment Authority (CSHLRA) to (according to their website) “bring life back to the Campus through an array of economic development tools while establishing strategic partnerships locally, at the State of Georgia and at the Federal level of government.” A church, small technology firm and a school are looking to use small sections of the property. Efforts to save some of the decaying historical buildings are underway. Film and television location scouts have also become frequent visitors.
While visits to the hospital grounds are encouraged, unauthorized break-ins into the buildings are closely monitored and highly dangerous in spots. If you’d like to tour Central State Hospital, follow the map below and contact the Central State Hospital Local Redevelopment Authority (CSHRA):
Quotations 2-3 (and much research material) courtesy of:
Peter G. Cranford, But for the Grace of God: The Inside Story of the World’s Largest Insane Asylum, Milledgeville (Augusta, Ga.: Great Pyramid Press, 1981).
Special thanks to Kari Brown for helping with this article and providing photo descriptions.
Website for the Central State Hospital Local Redevelopment Authority (CSHRA), which hosts tours of the facility.
The Kingston Lounge:
Beautiful photo gallery of abandoned buildings at CSH.
A Real American Horror Story – Weather Channel video on the effects weather has had on the old buildings.
You can help keep the stories coming by making a donation to The Moonlit Road.com. Large or small, any amount helps!
38 Responses to “Central State Hospital (CSH), Milledgeville, Georgia”
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Thank you for the very informative article. Some of the names mentioned in it were kind of familiar to me because both of my parents were employed by CSH for most of their “working lives.” My father worked in at least two or three buildings – my mother, in two, also. I can recall only their last jobs…my father was an accountant there in the Lawrence building, and, my mother was an HST the Allen Building. Both are deceased, now, but they told me and my siblings many true stories about CSH. I also have a lot of memories about the buildings and the cafeteria as my father would sometimes bring food home for our supper. I also went on a school field trip in the fourth or fifth grade, back in 1972 or 1973. I forget the exact year, but, remember the trip “as if it was yesterday.” Thank you again for the article!
Thanks, Curtrice – I bet you have some interesting stories to tell!
Yes, this is a terrific and informative article! Love the pictures too.
My mother was a nurse here in the Arnold building. I can remember some of the photos and my dad drove the white transportation buses on the grounds and transported patients later back and to to Thomasville, Ga. I can relate to this story very well, enjoyed reading about what you all had to say…Thanks
Thank You for sharing. My family roots are deeply entwined in the history of Central State Hospital. My grandmother worked in the Jones Hospital, my mother grew up on the outskirts of CSH in the Hardwick Community. My mother and father met at a dance at Central State Hospital. My father was a patient at CSH in 1964 and again in 1971. My father should have never been released from the hospital, my parents should have never met or allowed to marry. I have so many questions but no one wants to talk about the DEEP DARK SECRETS OF CENTRAL STATE HOSPITAL
I loved reading this. My Grandmother was sent there for a short time probably 25 years ago. I just remember the buildings being overwhelming! I didn’t know you could tour the buildings. Very neat to know.
Jan Smith Davis:
I am floored at the numbers listed here! So many!!! And a railroad station on-site?!!! I do not really understand how people went unaccounted for, though. If they were placed as a result of a court order or diagnosis, were there not records for each admission?
Growing up in Milledgeville I remember most all of the budings and pictures in your article. I roamed the grounds several times. We even playing high school basketball games in the gym. Now that I grown and have a famy of my own I have taken them to visit the grounds and told them many stories! Very interesting then and still is. I remember the gift shop the patients made things for and even have a wedding gift from there that was given to me!
Thanks for the wonderful read!
Very informative article. I remember some of the names from stories my father told me when I was a child. He ran the morgue at CSH for 16 years before it was bidded out to private funeral homes in the early 80′s.
Thank you for this article. i grew up in milledgeville.. then married and lived a stones throw away from it.. i find the history on it fascinating.. my brother is skitsophrenic and has visited this hospital for treatment for as long as i can remember. that hospital has done a great many things. thank you very much
I worked in the Yarbrough Building in the early 1970s. Amazing article.
I was a patient in the Adolescent Ward in 1975 and then moved to the Yarborough building. Distinctly remember alot of activities in the school, ward and Yarborough building that have remained unspoken. Remember Bart Martindale, the school psychologist paricularly. My crime? Runaway from home.
i loved reading this . i love anything with history. ive been by the csh many times from living so close by and my great aunt working there . altough she never wanted to talk about her job there . it seem to give her the chills when i would ask about it . thanks again
Is there any way to access medical records of a deceased family member that was sent there in the 1950- 1960s and also died there?
Rebecca, I don’t know how good their record keeping is. I think a lot of things are in storage. You may wish to contact the organization we link to in the article and see if they can forward you to the proper people.
still waiting to receive my Great grandfathers medical records. I was called over a month ago. Hoping it will give more insight on his final days and condition.
Good article. I was born and raised in Milledgeville. My family and I lived very close to the hospital grounds. I remember my friends and I riding our bikes around the hospital grounds, marveling at the buildings, the acreage, and the activites we saw taking place. Most of my family worked at the hospital and retired from there. I also had a Post traumatic stressful grandmother and 2 mentally retarded aunts admitted there for a while for treatment. I grew up, became a nurse and worked there too. The hospital not only offered job security to many in the community but it also offered intensive treatment and extracurricular activities to its clients. Now that the hospital is closed, I can’t imagine whats happening to all those clients who really need long term treatment and a sense of family that understands their needs.
My mother and father worked at the hospital my mother retired from the hospital and so did several of my ants and cusions If you worked there you had medical care provided so guess what I was bore there in the jones building I also worked there for a while so living in Hardwick I have a lot of memories of the place to bad its just falling down hope the state can come for some good use for it
Thank you for this well-written article. I appreciate the way you communicated the history without over-dramatizing. My grandmother was a resident for more than 20 years. In the mid-1980′s CSH was the only facility in the area that would accept Alzheimer’s patients. It is amazing how much changed at the hospital from that time until her death in 1996. When she entered, the atmosphere was very much a “ward” with heavy metal doors, stark visiting areas, and strict rules. It felt like an “institution” when I visited her. However, as time went by and the status of the hospital changed to a nursing home, the atmosphere changed, too. Some of the buildings were updated and remodeled. The last building she was in (I don’t remember the names now) was nice and felt like a good place to be. We were free to visit in her room, and we could help feed her when we were there. The Nursing staff was very caring.
No one wants to have to send away a family member, but for my family CSH was a godsend when we had no way of giving our loved one the care she needed.
hey there, thanks for the great blog entry! an amazing place indeed. my last record was conceptually inspired/informed by this place. find out more here, if anyone’s interested: http://www.marktulk.com/
Dr. Wm. L. Wiley:
Sad. So very, very sad.
The photo showing the iron stakes is a representation of the many stakes recovered after being tossed aside by groundskeepers. There are no little boxes of remains from Negro patients entombed at that site. The graves from the Negro cemetery that were moved to make way for the Rivers complex were respectfully reburied in order at another burial ground on campus. There are several cemeteries including the current one where patients are still being buried…not to hide abuse…but to respect their privacy which was thought of as more respectful at the time…Census records only gave initials…photos (and videos) that sought to exploit someones’ misfortunate circumstance…were and still are prohibited.
Jones, thanks for your response. The caption below the photo you speak of says the graveyard pictured is a representation. Though since this is featured around the information on Negro burials it may have been unclear. Thanks for the clarification, though.
I work at CSH in Plant Operations.
Many of the old buildings require some work, but most are sound enough to be repurposed. The pecan grove is lovely, and the buildings around it have more atmosphere and aesthetics than any modern office park. The railroad station houses a small museum of the hospital’s history.
Anyone interested in tracing a relative should contact hospital administration. I’ve seen record books (not the contents) that look as old as the hospital, so you should be able to find out what happened. (In the past, people from as far away as New York were admitted.)
Worked for Central State Hospital from 1962 until 1974. Worked in the Freeman Building for 14 months then worked in the Telephone Office there . Was not crazy about working in the Freeman Bldg but it was ok. Loved the telephone office. Then I transfered to DOAS with State gf Georgia in the office with Tommy Spivey. Worked in that office until I retired in 1996.
my grandmother barbara brown longshore died in the mental hospital in milledgeville georgia sometime in 1976. I would love to learn about her and her records from there. How would i get that information ?
Why has this not been presented to a respectful documentary film producer? Great historical story of early days of mental illness treatment! Hope someone will one day do a documentary film on this! Thanks for the great article and unknown background, even to those who grew up in Georgia, but didn’t know the history!
Sister did a semester there in psych rotation for Nursing School….Experience she will never forget! Thanks for the respectful but historical article. Getting lots of response comments to my facebook post. So many never knew the history, but had lots of relatives with connections to CSH, as patients, or worked there or did training there!
Joann, I’ve heard there is a small documentary in the works but there’s probably a larger story to be told. Thanks, we’re glad you enjoyed the article!
Martha Smith Solomon:
Shame that such a beautiful hospital has to be torn down. I was born in the Jones Building. My father worked at the hospital in the 1940s. At that time medical services were free to employees and their family. I have a great grandmother buried in one of the cemeteries. The people at the hospital helped to locate her. We placed a marker and some of our family puts flowers there on special occasions. I really hate to see the hospital go. Some of the early buildings are beautiful and hold many memories. May God Bless everyone who has passed through this hospital. Most of the people in Georgia has had some connection to Central State Hospital.
Martha, there are no plans as of now to tear the buildings down. But Jones is in bad shape as you can see in the photos.
Three of my four grandparents worked at CSH back in the 60s-80s, and my mom was an Operating Room R.N. at the Jones building for over 20 years. I used to come there after school some days and play in and wander the halls of the Jones Building. It was a really neat place. My Grandmother also worked there in timekeeping, and I’d visit her in her office for hours. So many memories there! Also, my sister was married at the Chapel of All Faiths on the grounds in 1996…….was a beautiful old church back then. What a great article about its history! I would really love to see a good documentary about the place that has so many memories for me and my family!
My great grandfather was railroaded to that place between 1940 and 1959 when he died there. I’m sure there are some good things that happened at this hole but for tens of thousands of poor souls, they would have macabre stories to tell that would make anyone’s blood curdle. What started as a pretty good idea in the early 1800′s turned into a concentration camp where murderers and rapists walked the halls and grounds and I’m not referring to just the patients. The proper way to find out or retrieve records for a past patient is to email the person in charge of this particular dept. and I don’t believe they even reply, even if this is the proper procedure. I called the number listed and I honestly believe the person that answered the phone was asleep just before they answered the phone, and definately did not care what I may have been calling about, much less helping me
As part of my nursing school training, I spent a rotation in 1961 at this hospital. We lived in a building run by trustee patients. My memories are still incredibly vivid of the patients and staff there. Some memories are very painful to recall, some are very poignant, some are funny. The students were used as staff. We had classes taught by nurses and trustee patients as assistants. Thorazine was just being used. I remember the patients lined up at the nurses station to receive the liquid medication. I also remember “shock” day when electrotherapy was performed like an assembly line. We were there for a couple of months, very long months. It was a valuable part of our education. A very special time.
Did this hospital not have to report deaths to the state the same as every other individual or institution did? I know for a fact that Grover Cleveland Coffey died there in 1940 but cannot find a death certificate anywhere.
My Great Grandfather John A. Nicholson died there and buried in grave #110 his son-my Grandfather Hubert L. Nicholson also died there and is buried in Blue Ridge, Ga.