Rhode Island State Hospital - Butler Hospital

When was this Asylum opened and what did it look like?

Butler Hospital was founded in 1844 as Rhode Island's first exclusively mental health hospital. Industrialist Cyrus Butler donated heavily to the hospital, and it was named in his honor. Hospital was constructed in 1870, and that November 118 mental patients were admitted - 65 charity cases from Butler Asylum, 25 from town poor houses and 28 from asylums in Vermont and Massachusetts where the state had sent them.

Hospital was constructed in 1870, and that November 118 mental patients were admitted - 65 charity cases from Butler Asylum, 25 from town poor houses and 28 from asylums in Vermont and Massachusetts where the state had sent them. 

In 1888, the General Assembly appropriated funds for a new almshouse to replace the frame building that had been originally built for the insane. Known now as the Center Building, the Almshouse was also designed by Stone, Carpenter and Wilson. Its name acknowledges the prevailing trend in institutional design, as evidenced in the House of Correction and State Prison, as well: the installation of a large central administration building with office and residential facilities for the staff and public eating and worship spaces for the inmates who were segregated in wings flanking the central structure. In this case, the wings housed 150 men and 150 women and includes an additional wing, the children’s “cottage” for sixty children. Opened in 1890, the three-and a half story stone building stands as a series of long buildings running north-south and interrupted regularly by octagonal stair towers. Its handsome stone work and red-brick trim and its site behind copper beach trees on a bluff overlooking Pontiac Avenue make the Center Building one of the most visually striking structures in Rhode Island. Building styles included Tudor, Colonial Revival, and Gothic Revival, set within beautifully landscaped grounds.

The grounds at Butler Hospital are indeed beautiful.  My sister worked there as a nurse for several years. The grounds are amazing.

From: Indians, Insanity, and American History Blog; Asylums And Insanity Treatments 1800 – 1935

 Though few people would willingly go to an asylum, Butler Hospital’s original champions seemed to have made every effort to ensure the building was as beautiful and comfortable as its patient population would allow.

2) What was the original intent?

The patients at the State Asylum were poor and believed beyond help, as is reflected in the evolution of names for the asylum. Initially it was to be called the State Insane Asylum; in 1869 the General Assembly adopted a resolution that the State Asylum for the Insane should serve as a receiving hospital for all types of mental disorder, acute as well as chronic, thereby merging the two.  “Undesirable” elements, the poor, the incurable, and the foreign born, the upper and middle classes thus restricted their own ability to use it. Therapy was second to custody.

From: Butler Hospital: Its Story (1926)

BUTLER HOSPITAL, located in Providence, R. L, had its origin in a bequest of the sum of $30,000 by the Hon. Nicholas Brown, who died in 1841. His will provided for a

hospital "where that unhappy portion of our fellow beings who are by the visitation of Providence deprived of their reason, may find a safe retreat, and be provided with whatever may be conducive to their comfort and to their restoration to a sound state of mind."

The able and benevolent Dorothea Lynde Dix was just beginning her notable crusade for a more humane and scientific treatment of the insane. Her investigations led her to Rhode Island, where she discovered two things. First, she struck upon scenes of misery almost beyond belief, scenes in deep stone dungeons without light or air, where insane persons were entombed in living death. Second, she found that "there existed in the City of Providence a small asylum, conducted on wise and humane principles, but totally

inadequate to the demands made upon it." Miss Dix resolved that an appeal to the wealthy and humane for the immediate enlargement of this asylum was a

step that must be taken.

Having complied with all the conditions laid down in the

Hon. Nicholas Brown's will, and finding their work good, the

trustees, in a meeting held November 8, 1844, unanimously

voted to change the name of the institution from the "Rhode

Island Asylum for the Insane" to "Butler Hospital for the

Insane." In doing so they not only honored the man whose

generosity made the institution practical, but they also more

fully described the purpose of the institution, — the word

"hospital" implying not only an "asylum" but also a place

where an enlightened and persistent effort is made to cure the

patients of their illness.

Who Were the Patients? Do narratives of their experiences exist?

The only patient story I could find was from the Butler Hospital: Its Story (1926)

A WOMAN broken, dejected, almost obvious of every-

thing about her, sits in her room in the ward in Butler

Hospital where acute cases are cared for. Her head is hang-

ing. Her body droops forward. She opens her mouth only

when a spoon or glass with food or drink is pressed to her lips.

Still, there is a little flush of health creeping back into her

cheeks. Her condition is much better now than it was when

she arrived a few days ago. Then she was mumbling con-

stantly. Her listless eyes saw nothing. She was rapidly

going down hill. Now she is gradually regaining mental and

physical health.

She had been poor . . . worked hard . . . had three

children in four years . . . her husband had lost his position

. . . one of her children had contracted influenza ... in

caring for the child she, too, was taken sick. She broke

beneath the strain.

Because of her nervous condition she could not be cared for

in a general hospital. But at Butler, mind and body alike will

be cared for. To nurse her back to health and reason and

strength is not impossible. Like others brought to Butler

Hospital for care, she will be studied and helped, will be rested

and taught, will be given every opportunity for rest and for

recovery.

The pervading atmosphere of Butler Hospital is one of

rest. You feel the spirit of peace everywhere. It is in the

beauty of the spacious fields, the verdure of cool forests, in the

ravines and brooks and beautifully-kept old trees that stand

sentinel to keep the noisy confusion of the outside world from

entering. Everywhere there is a calm atmosphere which will

quiet overwrought minds and relieve the tension of mental

excitement.

Grounds and buildings are peaceful. There is no bustling

of nurses — only a quiet precision. Everything is done to

Broad lawns, shaded by century-old trees, surround all the buildings,

and give the patients a stimulating outlook.

 

What was the patient experience like and did that change over time?

This Counselor could find little in the way of patient direct experiences. 

Via Google search, the following letter was found: 

Did the institution and its services and patients change over time?

It appears that part of Butler’s financial plan was to cater to the wealthy, by offering private rooms, effectively marketing the facility. As it was private, it considered itself not under public grant conditions.  When originally founded for the destitute, it became so overcrowded, that new buildings were built and funds raised as the need grew.

From Wikipedia’s (2017) description:

Butler Hospital is southeastern New England's only adolescent, and adult and senior psychiatric treatment center, providing assessments and treatment for all major psychiatric illnesses and substance abuse. There are six treatment units in the hospital's inpatient program and their partial (or day) hospital makes up an additional three units. Butler no longer has children's programs, as those were taken over by Bradley Hospital in East Providence.
As an internationally recognized research center, Butler participates in many research initiatives including studies in major depression, obsessive compulsive disorder, Alzheimer's disease and other memory disorders, depression and anxiety in dementia caregivers, substance abuse and family violence, smoking cessation, and movement disorders such as Parkinson's disease.
Butler Hospital employs approximately 950 full-time and part-time, clinical and non-clinical staff, in addition to more than 50 volunteers who assist in nearly all areas of the hospital.

Butler Hospital’s current website (http://www.butler.org/)lists the full range of psychiatric services which includes: Alcoholism and Drug treatment, Alzheimer’s, Huntington’s disease, Parkinson’s disease, etc. Thus its services include not only acute and chronic psychiatric disorders but also the mental health components of such conditions as Parkinson’s disease.

How many people lived, worked and died there?

In 1913, 2000 people were sleeping on the floor at the State Hospital for the Insane. Despite the building effort of the 1920s, in 1933 the State Hospital, with accommodations for 1,550, housed 2,235 and was labeled the most overcrowded mental hospital in the northeast. Despite the tremendous improvement made possible by the WPA, by 1947 conditions at Howard had once again deteriorated due to overcrowding. The Hospital for the Insane, built for 2,700 beds, held over 3,000 patients.

Were bad condition ever exposed to the public? How? 

It appeared that the Rhode Island legislature responded to complaints about overcrowding and the scathing reviews of experts.  From the Asylum’s Project’s Preserve Pretorius:

Interestingly, in 1959 an expert from Boston declared that the conditions at Howard were shameful and yet “relatively good” compared with mental hospitals in the country. The problem stemmed not from a lack in the annual budget (Rhode Island ranked twelfth nationwide in the amount spent per patient) but in the inability to raise capital funds to match federal programs.

In 1962, the General Hospital and State Hospital for Mental Diseases merged to become the Rhode Island Medical Center. The former became the Center General Hospital and the latter the Institute of Mental Health. In so doing, Rhode Island was the first state to create therapy units for its mentally ill, an approach pioneered at the Center General Hospital. As a result, four buildings housing elderly patients were transferred to the jurisdiction of the Cranston General Hospital in order to remove the stigma of residing in a mental hospital.

In 1967, the Medical Center was divided. The Center General Hospital was designated to serve as an infirmary for the prison and the Institute of Mental Health. Both hospitals are administered by a new Department of Mental Health, Retardation, and Hospitals, In 1977, the IMH was divided into nine units to deal with specific categories and regions of patients. The institution is currently undergoing another philosophical re-orientation, encouraging group homes away from the environment of Howard. The extent of this change will very likely depend on federal support, but if carried out extensively, it will help to redefine the role of Howard just as previous changes in attitude have.

Would I have wanted treatment in this institution?

Having worked at two institutions (Laconia State School and Brandon Training School), I have fond memories of my time working there.  In both institutions, there were expansive services, mostly caring staff and really good treatment teams. However, of course, patients were lodged in large wings, with beds, side by side, with strict rules and were often understaffed.

I would not want to live in this or any other institution. Although, I’m sure the care and living conditions are much better in this current age, Butler or any other psychiatric hospital, is still the most restrictive form of medical/psychiatric care. I would hope if I needed mental health services that I could be served in my own community while living in my own home.  In this current age of Visiting Nurses Association (VNA) where telemedicine is available, as well as community mental health and private clinicians, I would hope that I would be served by the most caring clinician of 
my choice.