In the 1830s, a reform movement swept several American states -- an impulse to improve prisons, build public schools, and create state-funded hospitals for the mentally ill. In 1837, the Georgia State Legislature, responding to a call from Governor Wilson Lumpkin, passed a bill establishing the "State Lunatic, Idiot, and Epileptic Asylum." The name alone speaks volumes about the era's understanding of mental illness. Milledgeville was then the state capital, and the facility opened there in 1842, accepting its first patient in December. Under Dr. Thomas A. Green, who served as superintendent from 1845 to 1879, the hospital pioneered what was called the "institution as family" model. Green abolished chain and rope restraints, ate meals daily with staff and patients alike, and tried to create an environment that resembled, however imperfectly, something like a home. It was an early and genuine attempt at humane care, even as the institution's capacity to provide it was already being outpaced by demand.

What began as a modest asylum grew relentlessly over the next century. Georgia sent its mentally ill, its developmentally disabled, its elderly, and its inconvenient to Milledgeville -- and the institution accepted them all. By the 1960s, Central State Hospital was contending with Pilgrim Psychiatric Center in New York for the grim distinction of being the largest mental hospital on earth. Nearly 12,000 patients occupied a campus of some 200 buildings spread across two thousand acres. The sheer scale defied comprehension: it was less a hospital than a small city, with its own farms, kitchens, laundry facilities, and cemeteries. Overcrowding was chronic. Staff-to-patient ratios were inadequate. The institution that Dr. Green had modeled on a family had become something closer to a warehouse, holding people whom society had decided it did not want to see.

Perhaps nothing captures Central State Hospital's history more starkly than its cemeteries. Scattered across the grounds, they hold the remains of more than 25,000 patients -- the vast majority buried in unmarked graves. For over a century, patients who died at the hospital and whose families did not claim their bodies were laid to rest without headstones, without names, without any record visible above the surface. The pecan groves and open fields that blanket parts of the campus conceal entire populations of the forgotten. These were not casualties of a single disaster or a brief period of neglect; they accumulated over decades, a slow accretion of lives deemed unworthy of remembrance. The graves stand as a rebuke to every era that contributed to them, and as a reminder that institutional care, however well-intentioned at its origin, can become its own form of erasure.

The deinstitutionalization movement that swept American psychiatry beginning in the 1960s hit Central State with particular force. As new medications and community-based care models emerged, the push to reduce asylum populations gained momentum. Central State's patient count fell from its peak of nearly 12,000 to a fraction of that number over the following decades. Buildings that had held hundreds of patients emptied and were shuttered. The Jones Building, constructed in 1929, stands abandoned -- a massive shell that speaks to the scale of what once operated inside it. Today, Central State Hospital continues to function on a vastly reduced scale, serving about 200 patients with short-stay acute treatment, residential programs for people with developmental disabilities, recovery programs requiring longer stays, and specialized nursing care. Some programs serve primarily the central Georgia region; others draw patients from across the state. The campus, with its pecan groves, its historic cemeteries, and its rows of silent buildings, remains one of the most haunting institutional landscapes in the American South.