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Am J Psychiatry 1965;122:679-686.
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University of Cincinnati College of Medicine. His address is 3333 Vine Street, Cincinnati, Ohio

Georgetown University School of Medicine and the District of Columbia General Hospital, Washington, D. C.

1966 by The American Psychiatric Association

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This study described a group of patients who, with few exceptions, were hospitalized after attempting to see the President at his official residence, the White House.In 1943, Dr. Jay L. Hoffman reported his survey of psychotic visitors to government offices which included 55 cases in the years 1927 and 1937, but only 28 of these were visitors to the White House. Most came to Washington to seek relief from persecution (21 cases). Dr. Hoffman suggested that the personality of the presidential incumbent and the current problems of the government influenced the type of patient and the number of patients hospitalized. He also considered them "the most potentially dangerous of all patients."To test these hypotheses, the charts of the 40 White House cases admitted to D.C. General Hospital in 1960 and 1961 were reviewed. In 1960, when Mr. Eisenhower was President, only nine patients were admitted, but 32 were hospitalized in 1961, Mr. Kennedy's inaugural year. This would suggest that some personal characteristic of the President was important.Finally, ten White House cases were seen in psychiatric interviews between October 1, 1963 and January 1, 1964, and all ten cases were briefly summarized. In general, the more recent White House cases were quite similar to the patients of 20 years ago.Based on the preceding data, the factors affecting the admission rate were discussed. The person of the President was important in some way. The surprisingly high number of foreign-born patients suggested a cultural determinant, although this could have been a function of the screening procedures by the Secret Service. To persist in trying to see the President, to give a history of previous mental illness and to be foreign-born were factors consistently found in the data.Finally, "centrality," "need for validation" and "pseudo-community"—concepts which have been proposed in recent publications about paranoid states—were discussed in relation to this specialized group of patients. In the opinion of the authors, none of these hospitalized patients represented a special threat to the life of the President, whom they incorporated as a benevolent and necessary agent in a paranoid pseudo-community.

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