Abandoned Central State Hospital in Milledgeville, Georgia is a decaying witness to changing attitudes toward mental illness and asylums.
If you are a Georgia native of a certain age, a scolding like this from your parents would make your blood run cold:
“You best behave yourself or I’m sending you to Milledgeville!”
You knew they weren’t talking about the charming, former state capital of Georgia with its grand antebellum homes, towering oak trees and vibrant universities. Instead, they were talking about Milledgeville’s sprawling, ominous mental asylum just a couple of miles up the road.
Known today as Central State Hospital, this now abandoned asylum was once one of the largest mental hospitals in the United States. Its long and often controversial history mirrors our country’s constantly changing attitudes toward mental illness.
Table of Contents
- Where is Central State Hospital in Georgia?
- Early Treatment of the Mentally Ill
- Milledgeville and the Civil War
- An Overcrowded Asylum
- Desperate Times, Desperate Measures
- Thousands of Unmarked Graves
- Is Central State Hospital Still Open?
- Photo Gallery
Where is Central State Hospital in Georgia?
Milledgeville (population 18,704) is the county seat of Baldwin County in central Georgia, 98 miles east of Atlanta. Central State Hospital, though only a couple of miles out of town (Google Maps), seems worlds away from Milledgeville’s quaint downtown district, a magnet for tourists and nearby college students.
Driving around the largely abandoned campus there is an eerie calm belying 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-inspired design sit decaying on the edges of a shady pecan grove. Their roofs are rotted and collapsed in spots, slowly succumbing to the elements. While inside, lead paint peels off the moldy walls, and thick vines slither through shattered windows.
While on the back side, more institutional-looking brick buildings dot the rolling hillsides once farmed by patients both as treatment and servitude. Acres of empty fields hold the remains of thousands of unidentified patients, many forever lost.
Some believe Central State Hospital is haunted. Not by one particular ghost or horrific event, but a compounding of many years of suffering. So-called “dark tourists” may flock to the campus these days. But the real story of Central State Hospital is a more complicated tale of good intentions, tragic mistakes and heroism. All mirroring our country’s changing attitudes toward the mentally ill.
Early Treatment of the Mentally Ill
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. As a result, people diagnosed (or misdiagnosed) as “lunatics” were often thrown in prison, shunned in communities or farmed out as virtual slaves. While others were simply the dirty secret best kept at home.
In Georgia, these attitudes began to change in 1834 when Governor Wilson Lumpkin, addressing public concern for the plight of those afflicted, fought for state care of the “idiots, lunatics and insane.” Consequently, the Georgia General Assembly approved the creation of a dedicated “lunacy commission.”
Milledgeville Physicians and the First Asylum
Among the first commission members were an influential group of physicians from Milledgeville, then the state capital and epicenter of wealth and power. Riding through Milledgeville at the time, it was common to find bustling 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. It would be the first institution of its kind to treat all three afflictions (as they were then known). Shortly thereafter, a 40 acre plot of land just two miles south of Milledgeville was purchased for $4000. This plot was chosen due to its proximity to town and the physicians’ practices. Milledgeville’s centralized location also made it convenient for statewide patients.
Five years later, this Milledgeville asylum was turned over to its trustees, who then appointed Dr. David Cooper as the first superintendent. These trustees were only reimbursed for their everyday expenses, as it was thought small salaries would not attract a high calibre of physician. But the trustees considered hospital work to be a public service. Hence, physicians like Dr. Cooper could continue their private practices in Milledgeville while also overseeing the asylum.
First Buildings and Patients
The first asylum 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. Oil lamps and torches provided light.
Men lived in the first two floors, while women occupied the top floors and were 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 the entire institution.
The first patients arrived with a variety of mental disorders, from religious hallucinations to paranoia, depression and alcoholism. Georgia residents deemed “lunatics,” “idiots” or “epileptics” had to first stand trial before a jury with at least one physician. If judged to be a danger to the community, they were sent to the Milledgeville asylum in chains. Unruly patients were locked in special, blue-colored rooms. If this soothing color didn’t work, they were chained to a chair in the corner to make sure.
“Institution As Family”
Dr. Cooper applied the then-radical model of the “institution as family.” He believed patients were best treated by an extended family of strangers. At home, the patients’ conditions might be misunderstood, or emotional attachments could keep them from being cured. Patients were encouraged to work in the garden, field or workshop to gain a sense of usefulness.
Another prominent Milledgeville physician named Dr. Thomas A Green became asylum superintendent in 1845. Dr. Green built upon the “institution as family” model. New patients would frequently arrive at the asylum 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, 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 were kept in isolation. Even when the institution became overcrowded, Dr. Green had a reputation for not turning people away.
Milledgeville and the Civil War
From the early days, funding the Milledgeville asylum was a challenge. At first it was believed the hospital could be partially self-sustaining by admitting paid patients. But this system soon became untenable.
Dr. Green asked for more state money to complete the hospital, build a library and chapel, and purchase more land. But with the Civil War ravaging the state’s cotton economy, families could no longer pay for treatment of their loved ones. Rising operational costs left 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, the hospital was already in dire straits. Though Sherman spared the hospital from destruction, it now had little support from the defeated state.
Dr. Green admitted refugees from other Southern states where hospitals were in Union 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, 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.
An Overcrowded Asylum
By 1872, 4 doctors treated 448 patients at the hospital, with an annual budget of $100,000. To control the population, Dr. Green only admitted non-violent patients, putting 2-3 together in small, 10-12 foot rooms. Dr. Green believed the earlier patients were treated (1 year or less), the more successful treatment would be and the patients could return 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. Dr. Powell immediately inherited the growing issue of patient overcrowding. The Milledgeville 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). Other patients simply had nowhere else to go.
Adding to the chaos, a law passed making the asylum free for all state citizens. Part of this reasoning was due to political pressure. State legislators were keen on taking care of patients from their home districts. While Milledgeville lawmakers wanted to keep the asylum 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 new law passed allowing patients to return home who were deemed incurable but harmless, to make room for those who could be treated. Dr. Powell 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.
Abuse, Neglect and Racial Tension
At the dawn of the 20th century, overcrowding had become a major problem at the facility now renamed the Georgia State Sanitarium. By 1910, 12 doctors cared for 3347 patients. Decrease in care was inevitable, with numerous reports of abuse, neglect, unsanitary facilities and seclusion rooms surfacing. Staff could only take care of the patients’ basic needs, unable to provide appropriate treatment for all their illnesses.
Many patients whose mental state was diagnosed as “unclassified” were simply lost in the system. This led to many stories – some true, others just folktales – of loved ones vanishing in the bowels of the sanitarium.
In 1921, 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 hospital staff member occurred. Amy Oxford, a popular nurse, was struck in the back of the head with an axe handle by a black patient, who then returned to his work quietly. As news spread, local townspeople broke into the building where the patient was in seclusion, killing him in the same manner.
Hospital staff still considered farm work a helpful activity for the patients. 800 acres of nearby farmland took care of the facility’s food needs, tended by the patients. Although this program offered little in the way of actual treatment, it developed and nurtured job skills the patients could use back home when discharged.
Desperate Times, Desperate Measures
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 expanded to include 132 more acres. Four new hospital buildings made of brick and modern interiors were built, plus a dedicated tuberculosis ward.
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 a month. It was later believed thousands of patients could have been sent home as harmless. Many patients claimed to have been “railroaded” into the institution by others, for various reasons.
But poor state financing and draining of able-bodied staff during World War II meant radical treatment was needed to stem the unrelenting tide of patients.
Shock Treatments and Lobotomies
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.
Hospital staff administered electroshocks at their discretion on a mass assembly basis. Patients were frequently confused if shocks were being given as treatment or punishment. Afterwards, nurses walked patients back to the day room in a stupor. While hospital chaos died down thanks to electroshocks, memory loss in patients was common, unpredictable and sometimes permanent – helping wipe out, as some advocates noted, any memories of abuse.
“Shock treatment makes you forget what you want to remember and remember what you want to forget.”Peter Cranford
BUT FOR THE GRACE OF GOD: MILLEDGEVILLE!
Lobotomies were introduced in 1951 for especially chronic cases. 125 severely ill patients were lobotomized, with only 24 able to return home. An unknown number became even worse.
Atlanta newspapers ran frequent articles on patient abuse and deteriorating hospital conditions, becoming one of the few advocates patients had. State politics continued to influence hospital policies, with the board pressured by politicians to appoint staff as political favors, and to patient levels 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.
Thousands of Unmarked Graves
“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.”Peter Cranford
BUT FOR THE GRACE OF GOD: MILLEDGEVILLE!
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 is actually a massive potter’s field for tens of thousands of patients, many feared lost forever.
In 1938, construction crews dug up an African-American cemetery to make room for a new building. With the caskets long disintegrated, remains were placed into small boxes and moved closer together to save space. These tiny plots were marked only by simple metal poles with identification numbers.
The use of these numbered poles instead of headstones was common on hospital grounds. It is believed around 30,000 patients are buried at Central State Hospital in six neglected cemeteries, both African-American and white. Consequently, Central State Hospital contains one of the largest graveyards in the world for people with mental disabilities.
Cedar Lane Cemetery
In the 1960s, prison inmates on groundskeeping detail tossed thousands of numbered markers into the woods without recording their locations. Other markers were lost in underbrush. As memories faded it was no longer clear where the true burial plots were. As a result, Central State Hospital Cemetery a.k.a. Cedar Lane Cemetery became one giant, unmarked plot.
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: Milledgeville!, recognized as the definitive history of the asylum.
Is Central State Hospital Still Open?
Toward the end of the 20th century, patient numbers at Central State Hospital dropped dramatically. With improved medications, home treatment, construction of new facilities statewide and less stigma toward mental illness, the need for such a massive and crowded institution died away. As of this writing only 165 seriously ill patients remain, committed by the courts.
Therefore, the question became what to do with the nearly 2000-acre campus. Once one of Milledgeville’s top employers, Central State Hospital’s downsizing was a significant economic blow to the community. But Milledgeville was not alone – numerous old asylums around the world suddenly became obsolete. So a worldwide movement began to reuse these asylum properties as everything from arts centers and offices to high end condos.
For this reason, the state of Georgia tasked the Central State Hospital Local Redevelopment Authority (CSHLRA) with finding economic development opportunities on private, state or federal levels. In early 2019, the CSHLRA rebranded the hospital grounds as Renaissance Park to attract future investment.
While small businesses have since repurposed some of the inactive buildings, the challenge remains to find new economic partners. Especially for the large, decrepit buildings drawing the most interest from curiosity seekers.
Can You Tour Central State Hospital?
The Milledgeville Visitors Center now offers daily trolley tours of the campus grounds, including Cedar Lane Cemetery and the Chapel Of All Faiths.
The campus is home to numerous outdoor activities throughout the year, including a bike race, music and food festivals, and staff reunions in the beautiful pecan grove. The ME Film Festival even hosts a horror movie night on the grounds near the Chapel of All Faiths.
However, entrance into many of the historic hospital buildings is strictly forbidden. Decades of neglect have made these boarded-up buildings too hazardous to enter (any interior photos featured in this article were obtained with staff permission).
In short, society’s treatment of mental illness has come a long way from early religious zealotry to modern day home care and patient counseling. Central State Hospital in Milledgeville, Georgia stands as a silent monument to the timeline of psychological health in this country. To some it will always be a painful reminder of past abuse and trauma. But to others, the hospital was home to scores of tireless workers seeking to calm and treat mental afflictions we still struggle to understand.
All photos by Craig Dominey unless otherwise noted. All rights reserved.
Special thanks to Nancy Davisbray and Kari Brown at Georgia College & State University for all their help with this article.