On November 4, 1834, the General Assembly convened in Milledgeville, and then Governor Wilson Lumpkin made a plea on behalf of “the lunatics, idiots, and epileptics.” In 1837, Georgia legislators passed a bill for the creation of a state-operated insane asylum. After five years of construction, the Georgia State Lunatic Asylum opened in 1842. Over the years, the campus underwent several name changes including; Georgia State Sanitarium, Milledgeville State Hospital, and Central State Hospital.
Tillman Barnett, a 30-year-old farmer from Macon, was the first patient admitted to the new asylum in December 1842. He was brought to Milledgeville chained to a horse-drawn wagon by his wife and family, described as violent and destructive. Unfortunately, Barnett died of “maniacal exhaustion” by the following summer. Tillman Barnett became the first casualty in a long and dark history of one of the nation’s most notorious institutions.
Patient care at Central State Hospital was based on an “institution as family” model which asserted that hospitals worked best when they resembled an extended family. Head physician Dr. Thomas Green abolished chain and rope restraints, allowing patients to roam freely. Many of the patients were Civil War veterans who were unable to be cared for by their families. Black patients were admitted after the Civil War but were segregated to their own buildings until the 1940s. By the 1950s, Central State Hospital was the largest insane asylum in the United States, some say even the world. Over 12,000 patients were housed on the grounds. The asylum campus became its own town; complete with fire and police departments, a school, a church, and its own power, water, and steam plants.
Thousands of people were sent to Milledgeville, often with unspecified conditions, or disabilities that did not warrant a classification of mental illness. The hospital outgrew its resources and the patient-physician ratio was a miserable 100:1 in the 1950s. Many patients were subject to inhumane treatments including lobotomies, insulin shock, hydrotherapy, and early electroshock therapy along with far less sophisticated techniques. Children were confined to metal cages. Adult patients were forced to take steam baths and cold showers. Some were confined with straitjackets and treated with douches.
In 1959, the Atlanta Constitution’s Jack Nelson investigated reports of a “snake pit.” Nelson discovered that the thousands of patients at Central State were served by only 48 doctors, none a psychiatrist. To make matters worse, some of the “doctors” were actually patients who were hired off the mental wards. The series rocked the state. In the wake of the scandal, asylum staff were fired and Nelson won a Pulitzer. The state, which had ignored decades of pleas from hospital superintendents, began to provide additional funding. By the mid-1960s, as new psychiatric drugs allowed patients to move to less restrictive settings, Central State’s population began to steadily decline. A decade before the national movement toward deinstitutionalization, Georgia governors Carl Sanders and Jimmy Carter began emptying Central State in earnest, sending mental patients to regional hospitals and community clinics, and people with developmental disabilities to small group homes. However, this approach has been riddled with its tragedies, such as homelessness and drug abuse.
A 1999 U.S. Supreme Court ruling in a Georgia case allows patients with mental health problems to choose community care over institutionalization if a professional agrees. Following a 2010 agreement with the federal government, Georgia will move all mentally and developmentally disabled patients to community facilities. The same year Central State stopped accepting new patients. As the asylum buildings were vacated, four were converted into prisons. One prison remains on the property today. In a separate facility, the Cook Building houses 179 forensic patients (who have been found by courts to be not guilty by reason of insanity or incompetent to stand trial). Today, roughly a dozen patients remain at Central State, all elderly people awaiting alternative placements. The Central State Hospital Local Redevelopment Authority was created in 2012 by the state to revitalize and repurpose the property. Led by Milledgeville native Mike Couch, the authority has worked with real estate experts to develop a plan for reusing the property for businesses, schools, and recreation. By the end of 2015, the state Department of Behavioral Health and Disabilities, which operates Central State, will occupy only nine buildings.
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