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.
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.
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