Richard Nixon, the 36th President of the United States, is one of the most recognizable U.S. Presidents both here and abroad. His career included stints in the U.S. House of Representatives (2 terms, 1947-1950), Senate (part of 1 term, 1950-1953), and Vice President under Dwight Eisenhower from 1953-1961. In Congress, Nixon represented the state of California, his birthplace and longest residence. Nixon was elected president in 1968 when he ran against Hubert Humphrey. In 1972, he was re-elected by a landslide, winning 49 out of the 50 states. However, the actions he took to ensure his reelection, including the bugging of the Democratic National Committee offices at the Watergate Office Building, resulted in his resignation in August of 1974, as he faced impeachment by Congress.
Nixon’s psychiatrist, Hutschnecker, stated in interviews after the president left office that Nixon had “no serious psychiatric diagnosis… but he did have a good portion of neurotic symptoms.” Nixon had originally consulted the doctor about his somatic symptoms in the 1950s, when Hutschnecker was still working as an internist. At that time, he could have met DSM-IV criteria for Somatization Disorder. Beginning when he ran for president again in 1968 and continuing through his presidency, Nixon’s psychological symptoms became more marked. (Volkan,, Itzkowitz, & Dod, 1997). Based on the application of the Brief Psychiatric Rating Scale to that time period, his diagnosis would likely be (Axis 1) Psychotic Disorder Not Otherwise Specified along with (Axis 2) Narcissistic Personality Disorder. Nixon’s psychotic symptoms may have been a direct results of his narcissistic personality’s inability to cope with the stresses of his life. He had delusions that he could trust no one, which led him to be secretive, to misinterpret the actions and words of those close to him, to project his own feelings onto others, and to blame other for his actions (Chesen, 1975).
The criteria include a “pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.” Interpersonal relationships are often exploitative in nature. Nixon always wanted to be the best, the highest, the greatest, and the first (Black, 1999). In his career he collected ‘firsts,’ and even his funeral was the first presidential funeral at which five former presidents and their five first ladies were in attendance. He desperately wanted admiration at all times, and his fear of not getting admiration caused him to take many foolish actions (Volkan et al., 1997). Fear and the mistakes it caused fed into the psychotic breaks (primarily delusions) he experienced. Even when he was most popular, he sometimes believed he would lose, and he frantically tried to avoid loss. The Watergate break-in was a prime example of this. As described above, it was clear that he would be re-elected, but he didn’t feel certain. Also, he wanted a landslide and he feared he might not get it (Winters & Carlson, 1988).
The first nursing diagnosis for President Nixon is moderate to severe anxiety, evidenced by ruminative worrying (Black, 1999), attempts to control the environment and other people (Yuill, 2009), and distrust of others (Volkan et al., 1997). The second nursing diagnosis is defensive coping, seen in his denial of problems and weaknesses that were obvious to others (Black, 2008), projection of blame and responsibility (Volkan et al., 1997), hypersensitivity to criticism (Winters & Carlson, 1988), and rationalization of failures (Black, 2008).
Interventions for anxiety (with rationales in parentheses) include encouraging the patient to build a trusting relationship with the nurse (honesty, availability, and acceptance promote trust in the nurse-client relationship), provision of physical activities to release tension (tension and anxiety can be safely released with an additional physical benefit through physical activities), and teaching distraction techniques to avoid rumination (distraction techniques can “derail” the train of worry as it is starting, before it gets too powerful (Townsend, 2011).
Interventions for defensive coping (with rationales in parentheses) include recognizing and supporting basic ego strengths (self-esteem can be improved by concentrating on the positives of the personality), helping the client identify situations that provoke defensiveness (self-insight is a foundation of psychological health), and practicing more appropriate responses through role-playing (role-playing can increase the patient’s confidence that he can deal with difficult situations when they actually occur) (Townsend, 2011).
It is likely that, if President Nixon had sought treatment and if his difficulties had been diagnosed as listed above, he would have been helped by these nursing interventions.