The real gift the U.S. got in 1974 wasn't Gerald, it was Betty.
With the singular and notable exception of Eleanor Roosevelt, prior to Betty Ford there was a role expected of First Ladies, and they all accepted it (with perhaps the exception of the morose and vindictive Mary Lincoln, who certainly made her husband's job just that much more taxing). They were the 'national mom,' if you want, primarily in charge of choosing tableware for the white house, being a gracious wife and hostess and always sporting an impeccably maintained smile. If being President can sometimes be Hell, it had to have been that way for many a First Lady. There is even some evidence that Edith Wilson may have made some key Presidential decisions when her husband was incapacitated, but to all outward appearances she was no different than her predecessors. Whatever happened in the life of a First Lady, it was kept hidden from the world. The President could philander on her (as happened to numerous First Ladies, most notably Jackie Kennedy), beat her (Pat Nixon) or she could just plain have other trials in her life. She was also not expected to discuss anything controversial. If the First Lady made headlines, they were expected to be in the Society or the Fashion pages. Her job was to 1) not let it bother the President in his job, but to suffer in silence, and 2) to hide it from the nation. Even after leaving office, First Ladies were supposed to be better than perfect, and never have a care in the world beyond continuing to be a gracious hostess for their husband's visitors, and perhaps taking up a craft. And this fit with the times, because ultimately women, especially wives, were not supposed to be susceptible to the ugly realities of life.
Betty Ford changed all that. She went public, while her husband was in the White House, with her admission that she was a drug and alcohol abuser. Of course alcoholism was acknowleged as a problem at that time, but most people considered that all alcoholics were supposed to be men, and generally falling down drunk. Drug abusers, whether prescription or otherwise, were thought of as hopeless junkies that no one could do anything about.
But Betty Ford did. First she went to work on her own problems. By sharing them with the nation, she inspired thousands, maybe even millions across the nation to do the same thing. They knew they were not alone. And then she licked her problems, and she went a step farther and started the Betty Ford clinic, which has since helped tens of thousands of people with substance abuse problems beat those problems.
It's hard to remember how momentous that was. Before that time, people who outwardly were successful and might have been hiding a substance abuse problem had no place to go. It just wasn't talked about publically, especially for women. Today it seems that every time someone important like Mel Gibson or Mark Foley gets into trouble for their behavior they invariably blame substance abuse first and it's off to the rehab center. But in 1975 it was a different world, and it took a lot of courage for Betty Ford to do what she did. And by opening and pushing to success the prototype of a modern drug rehab center, she created a world where those who need help can get it.
Then at very nearly the same time, Betty Ford also announced that she had breast cancer.
In her own remarks to the American Cancer Society in 1975, she said,
I think their [her family's] surprise was a very natural reaction, because one day I appeared to be fine and the next day I was in the hospital for a mastectomy. It made me realize how many women in the country could be in the same situation.
That realization made me decide to discuss my breast cancer operation openly, because I thought of all the lives in jeopardy. My experience and frank discussion of breast cancer did prompt many women to learn about self-examination, regular checkups, and such detection techniques as mammography. These are so important. I just cannot stress enough how necessary it is for women to take an active interest in their own health and body.
Again, in those days breast cancer was something that most people didn't think about or talk about, and many women were on death's doorstep before they even realized what they had. Today you see pink ribbons all over for breast cancer research, but when Betty Ford first decided to talk about it, she was very much alone in talking about it.
I wish that Betty Ford had permanently changed the role of first lady, but honestly (with the exception of Hillary Clinton) I can't think of any since who haven't been limited to some version of 'impeccable hostess/stylish matron/strong wife and mother (though now there is the obligatory philanthropic pursuit).' Not that these things are in themselves bad things for a First Lady-- certainly Betty Ford was all of them while she was in the White House, but she also showed that just like the office of the President, the First Lady has what amounts to a 'bully pulpit' if she wants to use it, and can use it to do a lot of good in the world.