In December 1842, the Georgia State Lunatic, Idiot, and Epileptic Asylum opened its doors, becoming the State of Georgia's first psychiatric hospital. Over its 178-year history, the institution has changed names numerous times, also operating as the Georgia State Sanitarium, Milledgeville State Hospital, and Central State Hospital. By the 1960s, the hospital had grown to include 200 buildings encompassed on a 1750-acre campus, serving 12,000 patients, making the institution the largest mental hospital in the world. This impressive designation took place in a small rural town in Middle Georgia, which only had a population of 11,117 in 1960. Regardless of the lens used to view the history of mental health treatment in the United States, the institution located in Milledgeville, Georgia serves as a paradigm of the country’s checkered past in the treatment of people living with mental illness.
The story of Central State Hospital begins with the land itself, its contested history shaping the institution’s fraught legacy. In 1797, Fort Wilkinson was built on Muscogee land along the Oconee River, between a creek called Itchee-wam-otchee (Camp Creek) and another, further up the river, Thlock-laoso (Fishing Creek). Indigenous peoples had worked, nurtured, and produced knowledge here for millennia. Within five years, U.S. policies that purposely indebted the Muscogee Nation led to the 1802 Treaty of Fort Wilkinson, which stripped three million acres from the Nation and began the forced removal of Indigenous peoples. That same year, Georgia’s boundaries were fixed, and the state relinquished western lands in exchange for payment and federal promises to clear remaining tribal claims. In 1837, the last funds from these land sales—$44,000—financed Georgia’s first state asylum, built near the old fort, linking the institution’s founding to the dispossession that made it possible.
Central State Hospital rose on the outskirts of Milledgeville, Georgia’s frontier capital founded in 1804. Construction began after the 1841 establishment of a Board of Trustees, with the first building completed in 1842 and a women’s ward in 1847—both built largely by enslaved laborers and convicts. Governor Charles McDonald’s 1842 proclamation announced the new “Lunatic Asylum,” the first institution to treat the “lunatic, idiot, and epileptic.” Its first patient, Tilman Barnett, arrived chained to an ox cart and died six months later.
Construction of the Center, or Main Building, began in 1855 after years of appeals for more patient space. From this building, completed in 1858, the state’s asylum operated as both a model of progress and a reflection of the profound shortcomings that have marked the nation’s history in the treatment of mental illness. Dr. Thomas Green led the hospital from 1847 to 1878, a period during which the patient population surged from 60 to 738. By the end of his tenure, the institution maintained an extraordinary ratio—one physician for every 112 patients—allowing for daily medical visits, a standard never again matched in the hospital’s history. By World War II, that level of care had drastically declined, with only nine doctors responsible for 8,500 patients.
By the 1880s, the asylum was expanding rapidly, with its patient population far exceeding the intended capacity of 800. By 1882, it housed 979 patients, and administrators projected the number would reach 1,400 by 1884. To address the overcrowding, the state legislature approved the construction of three new buildings in 1881: one for Black patients—freeing their former quarters for white patients—the white Female Convalescent building, and the white Male Convalescent building, now known as the Walker Building. Overcrowding would continue to be a consistent problem. By the late-1930's, the sanitarium had over 7,000 patients housed in buildings with a rated capacity of 5,000. By the 1960s, the hospital had grown to include 200 buildings encompassed on a 1750-acre campus, serving 12,000 patients, making the institution the largest mental hospital in the world.
Mental illness has long been misunderstood, and the shifting, and often troubling, approaches to its treatment are reflected in Central State Hospital’s history. The institution moved from moral therapy, which emphasized compassion, faith, recreation, and purposeful work, to misguided practices such as psychosurgery and the overuse of psychotropic drugs. While the hospital both mirrored and shaped broader medical efforts to treat mental illness, societal stigma and dwindling state funding soon made meaningful care nearly impossible, reducing treatment to custodial confinement. Within this deeply flawed system, the chronically understaffed workers of Central State Hospital labored to provide care and maintain their own humanity.
Administrations of Lunacy
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Admission Register of Central State Hospital, Milledgeville, Georgia, 1842-1861
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Damnation hospital.
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Posey with the Insane and Sane
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Central State Hospital, Milledgeville, Ga digital exhibit illuminates the evolution of nursing training in the United States through the lens of the nursing experience at CSH and how the profession evolved over the course of the late 19 th Century and into the 20 th Century, focusing on the historical underpinnings that led to the formation of the CSH School of Nursing. The Twin Lakes Library, part of the Middle Georgia Regional Library System, partnered with Georgia College & State University to build this exhibit through the Georgia Public Library Service Digital Exhibits Pilot Program, which empowers libraries to use their unique digitized materials to tell the stories of their communities.
Common Heritage traveling/digital exhibit reflects on how the African American community has made change. Throughout the twentieth century, African American women and men gained incremental advances that collectively would transform the race’s agency, the self-determination to act independently and make their own free choices. African Americans, by creating their own organizations and institutions, developed ways to address their needs and aspirations that fostered the values of community, service, and mutual support.
The exhibit discusses African American Activism by Central State Hospital employees during the 1970s.
Unsilenced Voices: An Oral History Project of Central State Hospital is an emerging and ongoing oral history project to document the many stories that have become lost within the sensationalized history of the hospital, the tireless labor of the community to do good, despite the challenges. Central State Hospital (CSH), over its 180-year existence, holds a unique place within our nation’s contested past treatment of people living with mental illness, and has left an indelible mark on our community’s history and identity. Over the years, thousands of our community dedicated themselves to the success of the hospital and the care of the sick, creating a legacy of service Milledgeville may take pride in.
Transcripts of oral histories collected to date can be located on the Knowledge Box.