Asylum's dark past relived as cycle ends

After 170 years, all but one unit soon will be shut down for good

170 years at Milledgeville

Significant dates at Central State Hospital

1834: Georgia Gov. Wilson Lumpkin proposes a state asylum to treat "the lunatics, idiots and epileptics."

1842: The Georgia Lunatic Asylum in Milledgeville admits its first patient.

1860: The U.S. Census counts 283 patients in the asylum.

1864: With 30,000 federal troops occupying Milledgeville, William Tecumseh Sherman spares the state hospital from destruction.

1897: The hospital is renamed the Georgia State Sanitarium.

1929: The facility gets another new name: Milledgeville State Hospital.

1937: The hospital begins involuntary sterilizations for patients deemed mentally defective.

1940s: Electroshock therapy becomes routine as the hospital population grows to 10,000.

1951: Doctors begin performing lobotomies, using long metal picks to sever fibers that connect the frontal lobes to the rest of the brain.

1959: The Atlanta Constitution exposes horrific conditions at Milledgeville, the nation's largest psychiatric hospital with almost 13,000 patients.

1963: Forced sterilizations are discontinued. Georgia had sterilized 3,284 people, three-fourths of them psychiatric patients.

1967: Georgia begins opening regional psychiatric hospitals. The downsized Milledgeville facility becomes Central State Hospital.

1997: Mental-health advocates begin restoring Central State's cemeteries, where 25,000 patients were buried, many in graves no longer marked.

2007: The Atlanta Journal-Constitution reports on the suspicious deaths of 136 state hospital patients, 42 at Central State. In response, the U.S. Department of Justice opens an investigation.

2010: The state announces it will close most of Central State. By the end of 2013, only a secure facility for mentally ill criminal defendants will remain.

Barnett, a 30-year-old farmer from Bibb County, died six months later of a malady termed "maniacal exhaustion." Thus he became not only the first patient but the first casualty in the long and often dark history of one of the nation's most notorious mental institutions, known now as Central State Hospital.

That history played out in a seemingly endless cycle: good intentions, not enough money, poor psychiatric and medical treatment, too many patients with too few caretakers, abuse and neglect, expose and scandal, and, eventually, high-minded but fleeting reforms.

Only now, after 170 years, is the cycle breaking.

By the end of the year, Central State will operate only one hospital unit: a 184-bed secure facility that evaluates and treats criminal defendants who are mentally ill.

The state is shutting down the rest --- massive buildings that once warehoused 13,000 patients at a time --- to comply with a federal mandate to overhaul the way it provides psychiatric services. Across the nation, large institutions such as Central State, where abuse and neglect killed or injured hundreds, perhaps thousands, across the decades, are giving way to programs that treat patients in their communities.

Closing most of Central State, once the nation's largest psychiatric hospital, is "a huge symbol" of changing attitudes about people with mental illnesses, said Larry Fricks, a longtime patients' advocate.

"When we were growing up in Georgia, they used to say, 'If you don't behave, we'll send you to Milledgeville, ' " Fricks said recently. "Everyone knew what that meant. ... That was like a death sentence."

In its last days, though, Central State seems far less imposing.

Many of the 200 buildings on the 2,000-acre campus have become ghosts of their own pasts: windows shattered, porches sagging, roofs collapsed. Pine saplings sprout from the red-tile roof of the once-majestic Jones Building, where surgery was sometimes performed without a doctor present. Wild vines smother the brick walls and sunlight streams through the exposed ceilings of the Walker Building, where new patients waited as long as a year before getting psychiatric treatment.

"No trespassing, " small signs warn. "Unsafe building and grounds."

The hospital's grim history remains in plain sight in at least two places. One is a small museum in the hospital's former train depot. Among the relics on display are straitjackets that restrained patients, stainless-steel picks that were used to perform frontal lobotomies, and electroshock machines that dispensed what doctors jokingly called "the Georgia Power cocktail."

The other tangible link to the past can be found in the dozens of acres that hold the graves of more than 25,000 patients. Because so many patients lived at the hospital for so many years, often forgotten or shunned by their families, the hospital ran a mortuary and employed carpenters whose sole job was building caskets. For more than a century, the hospital buried its dead beneath small metal stakes, each emblazoned with a number that corresponded with a patient's file. No names. No dates of birth or death. No symbols of lives outside the hospital.

For grounds keepers, the markers amounted to a nuisance when they mowed the cemeteries. In the late 1960s, they simply pulled stakes from the ground --- at least 10,000 of them --- and tossed them into the woods.

Isolated in life, each grave's occupant would be forever anonymous in death.

'Sad procession'

On Nov. 4, 1834, when the General Assembly convened in Milledgeville, then Georgia's capital, Gov. Wilson Lumpkin made an impassioned plea on behalf of "the lunatics, idiots and epileptics."

"Every government possessing the means should without hesitancy provide suitable asylums for these most distressed and unfortunate of human beings, " Lumpkin said.

Legislators approved his proposal three years later. Construction took five more years. Finally, in November 1842, the Georgia Lunatic Asylum opened in the tiny community of Hardwick, on the outskirts of the capital. Six weeks later, a Milledgeville newspaper reported that a "sad procession" had brought the first patient, Tilman Barnett, chained to his wagon by his wife and other relatives.

Slowly at first, the hospital's registry of admissions shows, others followed: Samuel Henderson, 47, a farmer from Cobb County driven insane by "religious study, " who spent his final 11 years at Milledgeville. Juliana Mayer, 23, a "pauper, lunatic & epileptic" from Savannah, troubled by "disappointed affection, " who died of consumption after 9 1/2 years. Daniel Ashmore, 30, of Liberty County, who arrived "demented" from "intense application to study" and died in his sleep four years later.

Patients were admitted for "intemperance, " "religious excitement, " "domestic unhappiness, " "ill health and jealousy." One early patient was described as "rather idiotic."

Of the first 50 patients, 29 died without ever leaving. Records list causes of death as dysentery, chronic diarrhea, convulsions, and "general paralysis."

Just eight of the first 50 were pronounced "cured."

At the end of the hospital's first decade, the U.S. Census recorded 108 patients. Ten years later, census takers counted 283; they included two physicians, a lawyer, a bank officer and seven "lunatics of the same family."