Among the oldest psychiatric institutions in the United States, Butler Hospital was conceived and designed in the spirit of humanitarian reform for care of mental disorders. It was isolated from the city in the 1840s in a location on the Seekonk River providing a calming “asylum” removed from the pressures of urban life, then understood as a major cause of mental disturbance and derangement. The site has been somewhat reduced by the sale of portions of it for development, and expansion of facilities has taken its toll. Still, the grounds and the altered building core remain as a beautiful legacy of nineteenth-century planning for social and medical reform. Near the present entrance is the Richard Brown House (c. 1731). This gambrel-roofed farmhouse, one of the city's oldest—and, rare for Rhode Island, of brick—conveniently met the hospital's need for groundskeeper's housing. But such relics also played a modest role, as something ancient and rural and comforting, in supporting the healing process. Farther along, on the right, is the original entrance to the hospital, planted out but still visible with its gate intact.
The Neo-Tudor Gothic of the original hospital building, known as Center House, complemented the romantically wooded landscape and established the tone of subsequent architectural enlargements. Its program, which emphasized the need for abundant light and fresh air, resulted in a symmetrical E-plan composition of three-story hip-roofed pavilions (the middle wing extended a little beyond the others), with all three wings connected toward the rear of the complex by two stories of passageways. The original character of Center House can still be discerned, although it has been enlarged, both by raising its height to four stories and by the addition of more wings, while another recent addition has reversed the entrance front of the building from its original location facing the river. Later buildings follow its medievalizing lead: first Stone and Carpenter for David Duncan Ward (1873–1875); then Stone, Carpenter and Willson for Kane Gymnasium (1882), Sawyer House (1886–1888), and Duncan Lodge (1889); Hoppin and Ely for T. P. I. Goddard House (1897–1898) and Weld House (1900); and J. Robert Hillier for the enlargement of the initial Center House (1977).