It was once considered one of the world’s largest asylums, but now Georgia’s Central State Hospital sits mostly abandoned. Today, you can take a tour through the sprawling campus, which covers 2,000 acres and contains 200 buildings. However, the buildings are off-limits, and security has increased in recent years to ward off urban explorers and ghost hunters.

The hospital, often referred to as "Milledgeville" after the town where it's located, has been the subject of urban legends — many of them based on reality.

A bright start turns dark

The mental hospital in Milledgeville, which was once Georgia's capital, was commissioned by the state government in 1837 and opened five years later as the Georgia State Lunatic, Idiot, and Epileptic Asylum. Despite terminology that doesn’t fit with today's sensibilities, the hospital’s practices in the 1840s were humane and progressive for the time. Patients were not chained or restrained. Once patients were well enough, doctors encouraged them to participate in daily activities around the campus.

How did the Central State Hospital go from this relatively idyllic start to the 1950s and '60s, when reports portrayed it as an overcrowded facility with underqualified, overworked doctors who sometimes relied on treatments such as lobotomies, cold showers, shock therapy, confinement to metal cages and forced ingestion of nauseants? (These treatments were, at that time, considered acceptable.)

Even before Atlanta Constitution journalist Jack Nelson won a Pulitzer Prize for his exposé on the conditions inside Milledgeville, rumors were flying, doctors were pleading with authorities for help, and parents threatened to send their misbehaving children to the asylum unless they cleaned up their act.

Forgotten graves

Milledgeville Georgia mental institution burial site memorial These markers are a symbolic representation of the more than 25,000 patients buried in unmarked graves. (Photo: John Kloepper/Wikimedia Commons)

The main problem for the Milledgeville mental hospital was overcrowding. In the decades after the Civil War, the patient-to-doctor ratio at the facility ballooned to more than 100-to-1.

Also, mental health care and understanding of mental illnesses were very basic in the late 19th century. Treatments were rudimentary by today’s standards, and there was no distinction between people with legitimate mental illnesses and those whose personalities merely put them out of step with societal norms. Ill or not, many of Milledgeville's patients stayed for decades, and a large number never left.

As many as 25,000 people are buried on the campus. Some remains have been moved to designated cemeteries, but security guards often warn visitors not to walk on the lawns because of a danger of sinkholes caused by long-forgotten graves. Often, the staff would simply move the headstones and leave the graves under them unmarked. Cedar Lane Cemetery, which is part of the campus, now has about 2,000 cast-iron markers that commemorate all those buried around the campus.

Even after the media coverage of the 1950s, authorities acted slowly. It wasn’t until the 1960s, when new medications and a more-enlightened understanding of mental health care led to changes; Milledgeville patients were moved to other facilities or outpatient clinics. Today, almost all remaining residents are "forensic" patients housed in a secure facility because the courts found them not guilty by reason of insanity or mentally unfit to stand trial.

Milledgeville is actually a pleasant, historic town

Despite a name that still evokes images of the asylum and its history, Milledgeville is a pleasant college town with lots of history. Both Georgia College & State University and Georgia Military College are located here, and the historic and pedestrian-friendly downtown boasts boutiques, restaurants and a lively arts scene.

Despite these other features, the abandoned hospital remains an attraction. The town also has a small museum that features information about the asylum. Guided tours are sometimes available as well. Though the tours don't go into the buildings, visitors will see the cemeteries and grounds.

The buildings on the campus may seem imposing, but many are also fine examples of historic architecture. For more than a century, the Central State Hospital functioned almost like its own independent town. It had an auditorium, a dedicated train station, sports facilities and kitchens large enough to prepare food for thousands of residents. You can still see smokestacks, which were once part of a power generation facility that allowed the hospital to generate its own electricity.

There's a surprising amount of things to see here — and the history lesson will give you something to mull over long after you've left.

In a place once defined by the presence of an infamous psychiatric hospital, life goes on
What started in 1837 as the Georgia Lunatic Asylum in Milledgeville, Georgia, grew quickly to become the largest insane asylum in the world. Now, it sits empty.