Central State Hospital

Chartered in 1837, Central State Hospital was a product of the nineteenth century's social reform movement. Since its founding, the hospital not only has cared for thousands of patients but also has been the focus of political discussions in Georgia regarding the role of government and public health. By the 1960s Central State Hospital had become the largest mental health institution in the United States.
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.
In 1872 the hospital possessed a ratio of 112 patients per physician, a number that would not improve for almost a century. Central State underwent a dramatic increase in patient population during the second half of the century, when local communities began sending unwanted or problematic residents to the asylum, regardless of their diagnoses. The institution adjusted to this practice by developing increasingly more accurate methods of diagnosis and implementing differentiated ward placements under Superintendent Dr. Theophilus O. Powell, a noted scholar of psychiatry, who served from 1879 to 1907. In 1897 the hospital changed its name to the Georgia State Sanitarium.
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.
The advent of psychotropic drugs reduced the length of stay and made home return more feasible for acute patients, but the ultimate goal of reducing the patient population clashed with the institution's political self-interest. Memoirs and newspaper accounts from the 1950s and 1960s accused several Georgia politicians, including ex-Speaker of the House Roy V. Harris and state senator Culver Kidd, of coercing hospital administrators into hiring political patrons to fill jobs that would be endangered by a reduction in the patient population. The intense political pressure felt by all superintendents during the twentieth century was reflected in the words of Superintendent Dr. Y. H. Yarbrough, who, upon departing the hospital in 1948, said: "This is one of the happiest days of my life. In the hundred year history of this building, I am the only superintendent who hasn't been kicked out, or carried out feet first in a casket."
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.