Central State Hospital
Chartered in 1837,
Movements to reform prisons, create public schools, and establish state-run hospitals for the mentally ill swept across the nation during the first decades of the nineteenth century. In 1837 Georgia politicians responded by passing a bill calling for the creation of a "State Lunatic, Idiot, and Epileptic Asylum." Located in Milledgeville, the state capital at that time, construction of the facility was completed in October 1842, and the hospital admitted its first patient later that year.
Care of patients was based on the "institution as family" model, which asserted that hospitals were best organized when they resembled extended families. This model met with great success at Milledgeville, particularly under the leadership of Dr. Thomas A. Green, who served at the hospital from 1845 to 1879. Green ate with staff and patients daily and abolished such physical restraints as chains and ropes. The hospital also became increasingly custodial as the population evolved from the acutely disturbed to the chronically ill and organically disabled, many of whom were veterans of the Civil War (1861-65) with little chance of achieving a successful return to their families.
The patient population grew steadily throughout the twentieth century. The increase in numbers meant a concurrent decrease in the quality of care. Part of the extensive hospital grounds had been reserved for the planting of crops, and administrators had patients undertake the strenuous work of farming these acres. The work entailed little treatment on the part of the staff but often proved beneficial to patients who would return to farm life when discharged. The overwhelming number of patients also led to a pattern of conscious neglect, whereby hospital staff met the basic daily needs of their charges but were unable to provide appropriate treatment for their illnesses. Such brute-force interventions as insulin shock and electro-convulsive therapy occurred in massive numbers until the coming of chemical intervention, which in lieu of staff increases helped reduce the patient load of nearly 12,000 during the early 1960s. By this time the institution contended with New York's Pilgrim State Hospital as the nation's largest mental hospital. In 1967 the facility was renamed to its current title of Central State Hospital.
Since the 1960s the hospital has encountered increasing pressure to shift from the medical to the mixed-therapy model, a move notably supported by Georgia governors Ernest Vandiver Jr. and Jimmy Carter. Today Central State Hospital is no longer the state's only mental health facility. The construction of regional facilities has reduced Central State's population while helping to improve its level of care and expanding the variety of its client services, which today range from adult and adolescent mental health care to the provision of secure facilities for the state's criminal-justice system.
Constance Ledoux Book and David Ezell, "Freedom of Speech and Institutional Control: Patient Publications at Central State Hospital, 1934-1978," Georgia Historical Quarterly 85 (2001): 106-26.
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).
David H. Payne, University of Georgia
A project of the Georgia Humanities Council, in partnership with the University of Georgia Press, the University System of Georgia/GALILEO, and the Office of the Governor.