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In April 2020, Vanessa Guillén, a 20-year-old Army private, was bludgeoned to death by a fellow soldier at Fort Hood, in Texas. The killer, aided by his girlfriend, burned Guillén’s body. Guillén’s remains were discovered two months later, buried in a riverbank near the base, after a massive search.

Guillén, the daughter of Mexican immigrants, grew up in Houston, and her murder sparked outrage across Texas and beyond. Fort Hood had become known as a particularly perilous assignment for female soldiers, and members of Congress took up the cause of reform. Shortly after her remains were discovered, President Donald Trump himself invited the Guillén family to the White House. With Guillén’s mother seated beside him, Trump spent 25 minutes with the family as television cameras recorded the scene.

In the meeting, Trump maintained a dignified posture and expressed sympathy to Guillén’s mother. “I saw what happened to your daughter Vanessa, who was a spectacular person, and respected and loved by everybody, including in the military,” Trump said. Later in the conversation, he made a promise: “If I can help you out with the funeral, I’ll help—I’ll help you with that,” he said. “I’ll help you out. Financially, I’ll help you.”

Natalie Khawam, the family’s attorney, responded, “I think the military will be paying—taking care of it.” Trump replied, “Good. They’ll do a military. That’s good. If you need help, I’ll help you out.” Later, a reporter covering the meeting asked Trump, “Have you offered to do that for other families before?” Trump responded, “I have. I have. Personally. I have to do it personally. I can’t do it through government.” The reporter then asked: “So you’ve written checks to help for other families before this?” Trump turned to the family, still present, and said, “I have, I have, because some families need help … Maybe you don’t need help, from a financial standpoint. I have no idea what—I just think it’s a horrific thing that happened. And if you did need help, I’m going to—I’ll be there to help you.”

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A public memorial service was held in Houston two weeks after the White House meeting. It was followed by a private funeral and burial in a local cemetery, attended by, among others, the mayor of Houston and the city’s police chief. Highways were shut down, and mourners lined the streets.

Five months later, the secretary of the Army, Ryan McCarthy, announced the results of an investigation. McCarthy cited numerous “leadership failures” at Fort Hood and relieved or suspended several officers, including the base’s commanding general. In a press conference, McCarthy said that the murder “shocked our conscience” and “forced us to take a critical look at our systems, our policies, and ourselves.”

According to a person close to Trump at the time, the president was agitated by McCarthy’s comments and raised questions about the severity of the punishments dispensed to senior officers and noncommissioned officers.

In an Oval Office meeting on December 4, 2020, officials gathered to discuss a separate national-security issue. Toward the end of the discussion, Trump asked for an update on the McCarthy investigation. Christopher Miller, the acting secretary of defense (Trump had fired his predecessor, Mark Esper, three weeks earlier, writing in a tweet, “Mark Esper has been terminated”), was in attendance, along with Miller’s chief of staff, Kash Patel. At a certain point, according to two people present at the meeting, Trump asked, “Did they bill us for the funeral? What did it cost?”

According to attendees, and to contemporaneous notes of the meeting taken by a participant, an aide answered: Yes, we received a bill; the funeral cost $60,000.

Trump became angry. “It doesn’t cost 60,000 bucks to bury a fucking Mexican!” He turned to his chief of staff, Mark Meadows, and issued an order: “Don’t pay it!” Later that day, he was still agitated. “Can you believe it?” he said, according to a witness. “Fucking people, trying to rip me off.”

Khawam, the family attorney, told me she sent the bill to the White House, but no money was ever received by the family from Trump. Some of the costs, Khawam said, were covered by the Army (which offered, she said, to allow Guillén to be buried at Arlington National Cemetery) and some were covered by donations. Ultimately, Guillén was buried in Houston.

Shortly after I emailed a series of questions to a Trump spokesperson, Alex Pfeiffer, I received an email from Khawam, who asked me to publish a statement from Mayra Guillén, Vanessa’s sister. Pfeiffer then emailed me the same statement. “I am beyond grateful for all the support President Donald Trump showed our family during a trying time,” the statement reads. “I witnessed firsthand how President Trump honors our nation’s heroes’ service. We are grateful for everything he has done and continues to do to support our troops.”

Pfeiffer told me that he did not write that statement, and emailed me a series of denials. Regarding Trump’s “fucking Mexican” comment, Pfeiffer wrote: “President Donald Trump never said that. This is an outrageous lie from The Atlantic two weeks before the election.” He provided statements from Patel and a spokesman for Meadows, who denied having heard Trump make the statement. Via Pfeiffer, Meadows’s spokesman also denied that Trump had ordered Meadows not to pay for the funeral.

The statement from Patel that Pfeiffer sent me said: “As someone who was present in the room with President Trump, he strongly urged that Spc. Vanessa Guillen’s grieving family should not have to bear the cost of any funeral arrangements, even offering to personally pay himself in order to honor her life and sacrifice. In addition, President Trump was able to have the Department of Defense designate her death as occurring ‘in the line of duty,’ which gave her full military honors and provided her family access to benefits, services, and complete financial assistance.”  

The personal qualities displayed by Trump in his reaction to the cost of the Guillén funeral—contempt, rage, parsimony, racism—hardly surprised his inner circle. Trump has frequently voiced his disdain for those who serve in the military and for their devotion to duty, honor, and sacrifice. Former generals who have worked for Trump say that the sole military virtue he prizes is obedience. As his presidency drew to a close, and in the years since, he has become more and more interested in the advantages of dictatorship, and the absolute control over the military that he believes it would deliver. “I need the kind of generals that Hitler had,” Trump said in a private conversation in the White House, according to two people who heard him say this. “People who were totally loyal to him, that follow orders.” (“This is absolutely false,” Pfeiffer wrote in an email. “President Trump never said this.”)

A desire to force U.S. military leaders to be obedient to him and not the Constitution is one of the constant themes of Trump’s military-related discourse. Former officials have also cited other recurring themes: his denigration of military service, his ignorance of the provisions of the Uniform Code of Military Justice, his admiration for brutality and anti-democratic norms of behavior, and his contempt for wounded veterans and for soldiers who fell in battle.

Retired General Barry McCaffrey, a decorated Vietnam veteran, told me that Trump does not comprehend such traditional military virtues as honor and self-sacrifice. “The military is a foreign country to him. He doesn’t understand the customs or codes,” McCaffrey said. “It doesn’t penetrate. It starts with the fact that he thinks it’s foolish to do anything that doesn’t directly benefit himself.”  

I’ve been interested in Trump’s understanding of military affairs for nearly a decade. At first, it was cognitive dissonance that drew me to the subject—according to my previous understanding of American political physics, Trump’s disparagement of the military, and in particular his obsessive criticism of the war record of the late Senator John McCain, should have profoundly alienated Republican voters, if not Americans generally. And in part my interest grew from the absolute novelty of Trump’s thinking. This country had never seen, to the best of my knowledge, a national political figure who insulted veterans, wounded warriors, and the fallen with metronomic regularity.

Today—two weeks before an election that could see Trump return to the White House—I’m most interested in his evident desire to wield military power, and power over the military, in the manner of Hitler and other dictators.

Trump’s singularly corrosive approach to military tradition was in evidence as recently as August, when he described the Medal of Honor, the nation’s top award for heroism and selflessness in combat, as inferior to the Medal of Freedom, which is awarded to civilians for career achievement. During a campaign speech, he described Medal of Honor recipients as “either in very bad shape because they’ve been hit so many times by bullets or they’re dead,” prompting the Veterans of Foreign Wars to issue a condemnation: “These asinine comments not only diminish the significance of our nation’s highest award for valor, but also crassly characterizes the sacrifices of those who have risked their lives above and beyond the call of duty.” Later in August, Trump caused controversy by violating federal regulations prohibiting the politicization of military cemeteries, after a campaign visit to Arlington in which he gave a smiling thumbs-up while standing behind gravestones of fallen American soldiers.

His Medal of Honor comments are of a piece with his expressed desire to receive a Purple Heart without being wounded. He has also equated business success to battlefield heroism. In the summer of 2016, Khizr Khan, the father of a 27-year-old Army captain who had been killed in Iraq, told the Democratic National Convention that Trump has “sacrificed nothing.” In response, Trump disparaged the Khan family and said, “I think I’ve made a lot of sacrifices. I work very, very hard. I’ve created thousands and thousands of jobs, tens of thousands of jobs, built great structures.”

One former Trump-administration Cabinet secretary told me of a conversation he’d had with Trump during his time in office about the Vietnam War. Trump famously escaped the draft by claiming that his feet were afflicted with bone spurs. (“I had a doctor that gave me a letter—a very strong letter on the heels,” Trump told The New York Times in 2016.) Once, when the subject of aging Vietnam veterans came up in conversation, Trump offered this observation to the Cabinet official: “Vietnam would have been a waste of time for me. Only suckers went to Vietnam.”

In 1997, Trump told the radio host Howard Stern that avoiding sexually transmitted diseases was “my personal Vietnam. I feel like a great and very brave soldier.” This was not the only time Trump has compared his sexual exploits and political challenges to military service. Last year, at a speech before a group of New York Republicans, while discussing the fallout from the release of the Access Hollywood tape, he said, “I went onto that (debate) stage just a few days later and a general, who’s a fantastic general, actually said to me, ‘Sir, I’ve been on the battlefield. Men have gone down on my left and on my right. I stood on hills where soldiers were killed. But I believe the bravest thing I’ve ever seen was the night you went onto that stage with Hillary Clinton after what happened.’” I asked Trump-campaign officials to provide the name of the general who allegedly said this. Pfeiffer, the campaign spokesman, said, “This is a true story and there is no good reason to give the name of an honorable man to The Atlantic so you can smear him.”

In their book, The Divider: Trump in the White House, Peter Baker and Susan Glasser reported that Trump asked John Kelly, his chief of staff at the time, “Why can’t you be like the German generals?” Trump, at various points, had grown frustrated with military officials he deemed disloyal and disobedient. (Throughout the course of his presidency, Trump referred to flag officers as “my generals.”) According to Baker and Glasser, Kelly explained to Trump that German generals “tried to kill Hitler three times and almost pulled it off.” This correction did not move Trump to reconsider his view: “No, no, no, they were totally loyal to him,” the president responded.

This week, I asked Kelly about their exchange. He told me that when Trump raised the subject of “German generals,” Kelly responded by asking, “‘Do you mean Bismarck’s generals?’” He went on: “I mean, I knew he didn’t know who Bismarck was, or about the Franco-Prussian War. I said, ‘Do you mean the kaiser’s generals? Surely you can’t mean Hitler’s generals? And he said, ‘Yeah, yeah, Hitler’s generals.’ I explained to him that Rommel had to commit suicide after taking part in a plot against Hitler.” Kelly told me Trump was not acquainted with Rommel.

[From the November 2023 issue: The patriot]

Baker and Glasser also reported that Mark Milley, the former chairman of the Joint Chiefs of Staff, feared that Trump’s “‘Hitler-like’ embrace of the big lie about the election would prompt the president to seek out a ‘Reichstag moment.’”

Kelly—a retired Marine general who, as a young man, had volunteered to serve in Vietnam despite actually suffering from bone spurs—said in an interview for the CNN reporter Jim Sciutto’s book, The Return of Great Powers, that Trump praised aspects of Hitler’s leadership. “He said, ‘Well, but Hitler did some good things,’” Kelly recalled. “I said, ‘Well, what?’ And he said, ‘Well, (Hitler) rebuilt the economy.’ But what did he do with that rebuilt economy? He turned it against his own people and against the world.” Kelly admonished Trump: “I said, ‘Sir, you can never say anything good about the guy. Nothing.’”

This wasn’t the only time Kelly felt compelled to instruct Trump on military history. In 2018, Trump asked Kelly to explain who “the good guys” were in World War I. Kelly responded by explaining a simple rule: Presidents should, as a matter of politics and policy, remember that the “good guys” in any given conflict are the countries allied with the United States. Despite Trump’s lack of historical knowledge, he has been on record as saying that he knew more than his generals about warfare. He told 60 Minutes in 2018 that he knew more about NATO than James Mattis, his secretary of defense at the time, a retired four-star Marine general who had served as a NATO official. Trump also said, on a separate occasion, that it was he, not Mattis, who had “captured” the Islamic State.  

As president, Trump evinced extreme sensitivity to criticism from retired flag officers; at one point, he proposed calling back to active duty Admiral William McRaven and General Stanley McChrystal, two highly regarded Special Operations leaders who had become critical of Trump, so that they could be court-martialed. Esper, who was the defense secretary at the time, wrote in his memoir that he and Milley talked Trump out of the plan. (Asked about criticism from McRaven, who oversaw the raid that killed Osama bin Laden, Trump responded by calling him a “Hillary Clinton backer and an Obama backer” and said, “Wouldn’t it have been nice if we got Osama bin Laden a lot sooner than that?”)

Trump has responded incredulously when told that American military personnel swear an oath to the Constitution, not to the president. According to the New York Times reporter Michael S. Schmidt’s recent book, Donald Trump v. the United States, Trump asked Kelly, “Do you really believe you’re not loyal to me?” Kelly answered, “I’m certainly part of the administration, but my ultimate loyalty is to the rule of law.” Trump also publicly floated the idea of “termination of all rules, regulations, and articles, even those found in the Constitution,” as part of the effort to overturn the 2020 presidential election and keep himself in power.

On separate occasions in 2020, Trump held private conversations in the White House with national-security officials about the George Floyd protests. “The Chinese generals would know what to do,” he said, according to former officials who described the conversations to me, referring to the leaders of the People’s Liberation Army, which carried out the Tiananmen Square massacre in 1989. (Pfeiffer denied that Trump said this.) Trump’s desire to deploy U.S. troops against American citizens is well documented. During the nerve-racking period of social unrest following Floyd’s death, Trump asked Milley and Esper, a West Point graduate and former infantry officer, if the Army could shoot protesters. “Trump seemed unable to think straight and calmly,” Esper wrote in his memoir. “The protests and violence had him so enraged that he was willing to send in active-duty forces to put down the protesters. Worse yet, he suggested we shoot them. I wondered about his sense of history, of propriety, and of his oath to the Constitution.” Esper told National Public Radio in 2022, “We reached that point in the conversation where he looked frankly at General Milley, and said, ‘Can’t you just shoot them, just shoot them in the legs or something?’” When defense officials argued against Trump’s desire, the president screamed, according to witnesses, “You are all fucking losers!”

Trump has often expressed his esteem for the type of power wielded by such autocrats as the Chinese leader Xi Jinping; his admiration, even jealousy, of Vladimir Putin is well known. In recent days, he has signaled that, should he win reelection in November, he would like to govern in the manner of these dictators—he has said explicitly that he would like to be a dictator for a day on his first day back in the White House—and he has threatened to, among other things, unleash the military on “radical-left lunatics.” (One of his four former national security advisers, John Bolton, wrote in his memoir, “It is a close contest between Putin and Xi Jinping who would be happiest to see Trump back in office.”)

Military leaders have condemned Trump for possessing autocratic tendencies. At his retirement ceremony last year, Milley said, “We don’t take an oath to a king, or a queen, or to a tyrant or dictator, and we don’t take an oath to a wannabe dictator … We take an oath to the Constitution, and we take an oath to the idea that is America, and we’re willing to die to protect it.” Over the past several years, Milley has privately told several interlocutors that he believed Trump to be a fascist. Many other leaders have also been shocked by Trump’s desire for revenge against his domestic critics. At the height of the Floyd protests, Mattis wrote, “When I joined the military, some 50 years ago, I swore an oath to support and defend the Constitution. Never did I dream that troops taking that same oath would be ordered under any circumstance to violate the Constitutional rights of their fellow citizens.”  

Trump’s frustration with American military leaders led him to disparage them regularly. In their book A Very Stable Genius, Carol Leonnig and Philip Rucker, both of The Washington Post, reported that in 2017, during a meeting at the Pentagon, Trump screamed at a group of generals: “I wouldn’t go to war with you people. You’re a bunch of dopes and babies.” And in his book Rage, Bob Woodward reported that Trump complained that “my fucking generals are a bunch of pussies. They care more about their alliances than they do about trade deals.”

Trump’s disdain for American military officers is motivated in part by their willingness to accept low salaries. Once, after a White House briefing given by the then-chairman of the Joint Chiefs of Staff, General Joseph Dunford, Trump said to aides, “That guy is smart. Why did he join the military?” (On another occasion, John Kelly asked Trump to guess Dunford’s annual salary. The president’s answer: $5 million. Dunford’s actual salary was less than $200,000.)

Trump has often expressed his love for the trappings of martial power, demanding of his aides that they stage the sort of armor-heavy parades foreign to American tradition. Civilian aides and generals alike pushed back. In one instance, Air Force General Paul Selva, who was then serving as vice chairman of the Joint Chiefs of Staff, told the president that he had been partially raised in Portugal, which, he explained, “was a dictatorship—and parades were about showing the people who had the guns. In America, we don’t do that. It’s not who we are.”

For Republicans in 2012, it was John McCain who served as a model of “who we are.” But by 2015, the party had shifted. In July of that year, Trump, then one of several candidates for the Republican presidential nomination, made a statement that should have ended his campaign. At a forum for Christian conservatives in Iowa, Trump said of McCain, “He’s not a war hero. He is a war hero because he was captured. I like people who weren’t captured.”

It was an astonishing statement, and an introduction to the wider public of Trump’s uniquely corrosive view of McCain, and of his aberrant understanding of the nature of American military heroism. This wasn’t the first time Trump had insulted McCain’s war record. As early as 1999, he was insulting McCain. In an interview with Dan Rather that year, Trump asked, “Does being captured make you a hero? I don’t know. I’m not sure.” (A brief primer: McCain, who had flown 22 combat missions before being shot down over Hanoi, was tortured almost continuously by his Communist captors, and turned down repeated offers to be released early, insisting that prisoners be released in the order that they’d been captured. McCain suffered physically from his injuries until his death, in 2018.) McCain partisans believe, with justification, that Trump’s loathing was prompted in part by McCain’s ability to see through Trump. “John didn’t respect him, and Trump knew that,” Mark Salter, McCain’s longtime aide and co-author, told me. “John McCain had a code. Trump only has grievances and impulses and appetites. In the deep recesses of his man-child soul, he knew that McCain and his achievements made him look like a mutt.”

Trump, those who have worked for him say, is unable to understand the military norm that one does not leave fellow soldiers behind on the battlefield. As president, Trump told senior advisers that he didn’t understand why the U.S. government placed such value on finding soldiers missing in action. To him, they could be left behind, because they had performed poorly by getting captured.

My reporting during Trump’s term in office led me to publish on this site, in September 2020, an article about Trump’s attitudes toward McCain and other veterans, and his views about the ideal of national service itself. The story was based on interviews with multiple sources who had firsthand exposure to Trump and his views. In that piece, I detailed numerous instances of Trump insulting soldiers, flag officers and veterans alike. I wrote extensively about Trump’s reaction to McCain’s death in August 2018: The president told aides, “We’re not going to support that loser’s funeral,” and he was infuriated when he saw flags at the White House lowered to half-mast. “What the fuck are we doing that for? Guy was a fucking loser,” he said angrily. Only when Kelly told Trump that he would get “killed in the press” for showing such disrespect did the president relent. In the article, I also reported that Trump had disparaged President George H. W. Bush, a World War II naval aviator, for getting shot down by the Japanese. Two witnesses told me that Trump said, “I don’t get it. Getting shot down makes you a loser.” (Bush ultimately evaded capture, but eight other fliers were caught and executed by the Japanese).

The next year, White House officials demanded that the Navy keep the U.S.S. John S. McCain, which was named for McCain’s father and grandfather—both esteemed admirals—out of Trump’s sight during a visit to Japan. The Navy did not comply.

Trump’s preoccupation with McCain has not abated. In January, Trump condemned McCain—six years after his death—for having supported President Barack Obama’s health-care plan. “We’re going to fight for much better health care than Obamacare,” Trump told an Iowa crowd. “Obamacare is a catastrophe. Nobody talks about it. You know, without John McCain, we would have had it done. John McCain for some reason couldn’t get his arm up that day. Remember?” This was, it appears, a malicious reference to McCain’s wartime injuries—including injuries suffered during torture—which limited his upper-body mobility.  

[Jeffrey Goldberg: Trump: Americans who died in war are ‘losers’ and ‘suckers’]

I’ve also previously reported on Trump’s 2017 Memorial Day visit to Arlington National Cemetery. Kelly, who was then the secretary of homeland security, accompanied him. The two men visited Section 60, the 14-acre section that is the burial ground for those killed in America’s most recent wars (and the site of Trump’s Arlington controversy earlier this year). Kelly’s son Robert, a Marine officer killed in 2010 in Afghanistan, is buried in Section 60. Trump, while standing by Robert Kelly’s grave, turned to his father and said, “I don’t get it. What was in it for them?” At first, Kelly believed that Trump was making a reference to the selflessness of America’s all-volunteer force. But later he came to realize that Trump simply does not understand nontransactional life choices. I quoted one of Kelly’s friends, a fellow retired four-star general, who said of Trump, “He can’t fathom the idea of doing something for someone other than himself. He just thinks that anyone who does anything when there’s no direct personal gain to be had is a sucker.” At moments when Kelly was feeling particularly frustrated by Trump, he would leave the White House and cross the Potomac to visit his son’s grave, in part to remind himself about the nature of full-measure sacrifice.

Last year Kelly told me, in reference to Mark Milley’s 44 years in uniform, “The president couldn’t fathom people who served their nation honorably.”

The specific incident I reported in the 2020 article that gained the most attention also provided the story with its headline—“Trump: Americans Who Died in War Are ‘Losers’ and ‘Suckers.’” The story concerned a visit Trump made to France in 2018, during which the president called Americans buried in a World War I cemetery “losers.” He said, in the presence of aides, “Why should I go to that cemetery? It’s filled with losers.” At another moment during this trip, he referred to the more than 1,800 Marines who had lost their lives at Belleau Wood as “suckers” for dying for their country.

Trump had already been scheduled to visit one cemetery, and he did not understand why his team was scheduling a second cemetery visit, especially considering that the rain would be hard on his hair. “Why two cemeteries?” Trump asked. “What the fuck?” Kelly subsequently canceled the second visit, and attended a ceremony there himself with General Dunford and their wives.  

White House Chief of Staff John Kelly and Chairman of the Joint Chiefs of Staff Joseph Dunford visit the Aisne-Marne American Cemetery and Memorial in Belleau, France, in November 2018. (Shealah Craighead / White House)

The article sparked great controversy, and provoked an irate reaction from the Trump administration, and from Trump himself. In tweets, statements, and press conferences in the days, weeks, and years that followed, Trump labeled The Atlantic a “second-rate magazine,” a “failing magazine,” a “terrible magazine,” and a “third-rate magazine that’s not going to be in business much longer”; he also referred to me as a “con man,” among other things. Trump has continued these attacks recently, calling me a “horrible, radical-left lunatic named Goldberg” at a rally this summer.

In the days after my original article was published, both the Associated Press and, notably, Fox News, confirmed the story, causing Trump to demand that Fox fire Jennifer Griffin, its experienced and well-regarded defense reporter. A statement issued by Alyssa Farah, a White House spokesperson, soon after publication read, “This report is false. President Trump holds the military in the highest regard.”

Shortly after the story appeared, Farah asked numerous White House officials if they had heard Trump refer to veterans and war dead as suckers or losers. She reported publicly that none of the officials she asked had heard him use these terms. Eventually, Farah came out in opposition to Trump. She wrote on X last year that she’d asked the president if my story was true. “Trump told me it was false. That was a lie.”

When I spoke to Farah, who is now known as Alyssa Farah Griffin, this week, she said, “I understood that people were skeptical about the ‘suckers and losers’ story, and I was in the White House pushing back against it. But he said this to John Kelly’s face, and I fundamentally, absolutely believe that John Kelly is an honorable man who served our country and who loves and respects our troops. I’ve heard Donald Trump speak in a dehumanizing way about so many groups. After working for him in 2020 and hearing his continuous attacks on service members since that time, including my former boss General Mark Milley, I firmly and unequivocally believe General Kelly’s account.”

(Pfeiffer, the Trump spokesperson, said, in response, “Alyssa is a scorned former employee now lying in her pursuit to chase liberal adulation. President Trump would never insult our nation’s heroes.”)

Last year, I published a story in this magazine about Milley that coincided with the end of his four-year term. In it, I detailed his tumultuous relationship with Trump. Milley had resisted Trump’s autocratic urges, and also argued against his many thoughtless and impetuous national-security impulses. Shortly after that story appeared, Trump publicly suggested that Milley be executed for treason. This astonishing statement caused John Kelly to speak publicly about Trump and his relationship to the military. Kelly, who had previously called Trump “the most flawed person I have ever met in my life,” told CNN’s Jake Tapper that Trump had referred to American prisoners of war as “suckers” and described as “losers” soldiers who died while fighting for their country.

“What can I add that has not already been said?” Kelly asked. “A person that thinks those who defend their country in uniform, or are shot down or seriously wounded in combat, or spend years being tortured as POWs, are all ‘suckers’ because ‘there is nothing in it for them.’ A person that did not want to be seen in the presence of military amputees because ‘it doesn’t look good for me.’ A person who demonstrated open contempt for a Gold Star family—for all Gold Star families—on TV during the 2016 campaign, and rants that our most precious heroes who gave their lives in America’s defense are ‘losers’ and wouldn’t visit their graves in France.”

When we spoke this week, Kelly told me, “President Trump used the terms suckers and losers to describe soldiers who gave their lives in the defense of our country. There are many, many people who have heard him say these things. The visit to France wasn’t the first time he said this.”

Kelly and others have taken special note of the revulsion Trump feels in the presence of wounded veterans. After Trump attended a Bastille Day parade in France, he told Kelly and others that he would like to stage his own parade in Washington, but without the presence of wounded veterans. “I don’t want them,” Trump said. “It doesn’t look good for me.”

Milley also witnessed Trump’s disdain for the wounded. Milley had chosen a severely wounded Army captain, Luis Avila, to sing “God Bless America” at his installation ceremony in 2019. Avila, who had completed five combat tours, had lost a leg in an improvised-explosive-device attack in Afghanistan, and had suffered two heart attacks, two strokes, and brain damage as a result of his injuries. Avila is considered a hero up and down the ranks of the Army.

It had rained earlier on the day of the ceremony, and the ground was soft; at one point Avila’s wheelchair almost toppled over. Milley’s wife, Holly­anne, ran to help Avila, as did then–Vice President Mike Pence. After Avila’s performance, Trump walked over to congratulate him, but then said to Milley, within earshot of several witnesses, “Why do you bring people like that here? No one wants to see that, the wounded.” Never let Avila appear in public again, Trump told Milley.

An equally serious challenge to Milley’s sense of duty came in the form of Trump’s ignorance of the rules of war. In November 2019, Trump intervened in three different brutality cases then being adjudicated by the military. In the most infamous case, the Navy SEAL Eddie Gallagher had been found guilty of posing with the corpse of an ISIS member. Though Gallagher was found not guilty of murder, witnesses testified that he’d stabbed the prisoner in the neck with a hunting knife. In a highly unusual move, Trump reversed the Navy’s decision to demote him. A junior Army officer named Clint Lorance was also the recipient of Trump’s sympathy. Trump pardoned Lorance, who had been convicted of ordering the shooting of three unarmed Afghans, two of whom died. And in a third case, a Green Beret named Mathew Golsteyn was accused of killing an unarmed Afghan he thought was a Taliban bomb maker. “I stuck up for three great warriors against the deep state,” Trump said at a Florida rally.

In the Gallagher case, Trump intervened to allow Gallagher to keep his Trident insignia, one of the most coveted insignia in the entire U.S. military. The Navy’s leadership found this intervention particularly offensive because tradition held that only a commanding officer or a group of SEALs on a Trident Review Board were supposed to decide who merited being a SEAL. Milley tried to convince Trump that his intrusion was hurting Navy morale. They were flying from Washington to Dover Air Force Base, in Delaware, to attend a “dignified transfer,” a repatriation ceremony for fallen service members, when Milley tried to explain to Trump the damage that his interventions were doing.

In my story, I reported that Milley said, “Mr. President, you have to understand that the SEALs are a tribe within a larger tribe, the Navy. And it’s up to them to figure out what to do with Gallagher. You don’t want to intervene. This is up to the tribe. They have their own rules that they follow.”

Trump called Gallagher a hero and said he didn’t understand why he was being punished.

“Because he slit the throat of a wounded prisoner,” Milley said.

“The guy was going to die anyway,” Trump said.

Milley answered, “Mr. President, we have military ethics and laws about what happens in battle. We can’t do that kind of thing. It’s a war crime.” Trump said he didn’t understand “the big deal.” He went on, “You guys”—meaning combat soldiers—“are all just killers. What’s the difference?”

Milley then summoned one of his aides, a combat-veteran SEAL officer, to the president’s Air Force One office. Milley took hold of the Trident pin on the SEAL’s chest and asked him to describe its importance. The aide explained to Trump that, by tradition, only SEALs can decide, based on assessments of competence and character, whether one of their own should lose his pin. But the president’s mind was not changed. Gallagher kept his pin.

One day, in the first year of Trump’s presidency, I had lunch with Jared Kushner, Trump’s son-in-law, in his White House office. I turned the discussion, as soon as I could, to the subject of his father-in-law’s character. I mentioned one of Trump’s recent outbursts and told Kushner that, in my opinion, the president’s behavior was damaging to the country. I cited, as I tend to do, what is in my view Trump’s original sin: his mockery of John McCain’s heroism.

This is where our conversation got strange, and noteworthy. Kushner answered in a way that made it seem as though he agreed with me. “No one can go as low as the president,” he said. “You shouldn’t even try.”

I found this baffling for a moment. But then I understood: Kushner wasn’t insulting his father-in-law. He was paying him a compliment. In Trump’s mind, traditional values—values including those embraced by the armed forces of the United States having to do with honor, self-sacrifice, and integrity—have no merit, no relevance, and no meaning.

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The twinge begins in the afternoon: toes. At my desk, toes, itching. Toes, toes, toes.

I don’t normally think about my toes. But as I commute home in a crowded subway car, my feet are burning, and I cannot reach them. Even if I could, what would I do with my sneakers? My ankles are itchy too. But I’m wearing jeans, which are difficult to scratch through, unless you have a fork or something similarly rigid and sharp. I contemplate getting off at the next stop, finding a spot on a bench, removing my shoes, and scratching for a while. But I need to get home. Growing desperate, I scrape at my scalp, which is not itchy. This somehow quiets things down.

I am full of these kinds of tricks. A lot of folks, if you tell them you’re itchy, will recommend a specific brand of lotion. I hate these people. My husband made me a T-shirt that reads yes, I have tried lotions. They do not work. No, not that one either. Zen types will tell you to accept the itch, to meditate on it, as you might do if you were in pain. These people have no idea what they are talking about. Watching someone scratch makes you itchy; worrying about something pruritogenic, like a tick crawling on you, makes you itchy; focusing on how itchy you are when you are itchy makes you itchier. The trick, if you are itchy, is to not think about it, using those ancient psychological tricks disfavored in today’s therapeutic environments: avoidance, deflection, compartmentalization, denial.

Cruelest of all are the people who tell you not to scratch. They have a point, I admit. Scratching spurs cells in your immune system to secrete the hormone histamine, which makes you itchy; in this way, scratching leads to itching just as itching leads to scratching. But if you itch like I itch, like a lot of people itch, there’s no not scratching. It would be like telling someone to stop sneezing or not to pee. “I never tell people not to scratch,” Gil Yosipovitch, a dermatologist at the University of Miami Miller School of Medicine known as “the godfather of itch,” told me, something I found enormously validating.

[Read: Another reason to hate ticks]

No, the techniques that work are the techniques that work. During the day, I pace. Overnight, when the itching intensifies, I balance frozen bags of corn on my legs or dunk myself in a cold bath. I apply menthol, whose cold-tingle overrides the hot-tingle for a while. I jerk my hair or pinch myself with the edges of my nails or dig a diabetic lancet into my stomach. And I scratch.

My body bears the evidence. Right now I am not itchy—well, I am mildly itchy, because writing about being itchy makes me itchy—yet my feet and legs are covered in patches of thick, lichenified skin. This spring, I dug a bloody hole into the inside of my cheek with my teeth. I’ve taken out patches of my scalp, shredded the edge of my belly button, and more than once, desperate to get to an itch inside of me, abraded the walls of my vagina.

During my first pregnancy, when the itching began, it was so unrelenting and extreme that I begged for a surgeon to amputate my limbs; during the second, my doctor induced labor early to stop it. Still, I ended up hallucinating because I was so sleep-deprived. Now I have long spells when I feel normal. Until something happens; I wish I knew what. I get brain-fogged, blowing deadlines, struggling to remember to-dos, failing to understand how anyone eats dinner at 8 p.m., sleeping only to wake up tired. And I get itchy. Maybe it will last forever, I think. It stops. And then it starts again.

One in five people will experience chronic itch in their lifetime, often caused by cancer, a skin condition, liver or kidney disease, or a medication such as an opiate. (Mine is caused by a rare disease called primary biliary cholangitis, or PBC.) The itching is the corporeal equivalent of a car alarm, a constant, obnoxious, and shrill reminder that you are in a body: I’m here, I’m here, I’m here. It is associated with elevated levels of stress, anxiety, and depression; causes sleep deprivation; and intensifies suicidal ideation. In one study, the average patient with chronic itch said they would give up 13 percent of their lifespan to stop it.

Yet itching is taken less seriously than its cousin in misery, pain. Physicians often dismiss it or ignore it entirely. Not that they could treat it effectively if they wanted to, in many cases. There are scores of FDA-approved medications for chronic pain, from ibuprofen to fentanyl. There are no medications approved for chronic itch. “Pain has so much more research, in terms of our understanding of the pathophysiology and drug development. There’s so much more compassion from doctors and family members,” Shawn Kwatra of the University of Maryland School of Medicine told me. Itch, he added, “is just not respected.”

Perhaps doctors do not respect it because, until recently, they did not really understand it. Only in the late aughts did scientists establish that itch is a sensation distinct from pain and begin figuring out the physiology of chronic itch. And only in the past decade did researchers find drugs that resolve it. “We’re having all these breakthroughs,” Kwatra said, ticking off a list of medications, pathways, proteins, and techniques. “We’re in a golden age.”

Once left to suffer through their commutes and to ice their shins with frozen vegetables, millions of Americans are finding relief in their medicine cabinet. For them, science is finally scratching that itch. Still, so far, none of those treatments works on me.

Itching is one of those tautological sensations, like hunger or thirst, characterized by the action that resolves it. The classic definition, the one still used in medical textbooks, comes from a 17th-century German physician: “an unpleasant sensation that provokes the desire to scratch.” Physicians today classify it in a few ways. Itching can be acute, or it can be chronic, lasting for more than six weeks. It can be exogenous, caused by a bug bite or a drug, or endogenous, generated from within. It can be a problem of the skin, the brain and nervous system, the liver, the kidneys.

Most itching is acute and exogenous. This kind of itch, scientists understand pretty well. In simplified terms, poison ivy or laundry detergent irritates the skin and spurs the body’s immune system to react; immune cells secrete histamine, which activates the nervous system; the brain hallucinates itch into being; the person starts to scratch. The episode ends when the offending irritant is gone and the body heals. Usually medicine can vanquish the itch by quieting a person’s immune response (as steroids do) or blocking histamine from arousing the nervous system (as antihistamines do).

Yet some people itch for no clear reason, for months or even years. And many itching spells do not respond to steroids or antihistamines. This kind of itch, until recently, posed some “fundamental, basic science questions,” Diana Bautista, a neuroscientist at UC Berkeley, told me. Scientists had little idea what was happening.

In the 1800s, physicians were studying the nervous system, trying to figure out how the body is capable of feeling such an astonishing panoply of sensations. Researchers found that tiny patches of skin respond to specific stimuli: You might feel a needle prick at one spot, but feel nothing a hair’s breadth away. This indicated that the body has different nerve circuits for different sensations: hot, warm, cold, cool, crushing, stabbing. (Migratory birds have receptors in their eyes that detect the world’s magnetic field.) The brain synthesizes signals from nerve endings and broadcasts what it senses with obscene specificity: the kiss of a raindrop, the crack of an electric shock.

In the 1920s, a German physiologist noted that when researchers poked a pain point on the skin, itch often followed ouch. This led scientists to believe that the sensations shared the same nervous-system circuits, with the brain interpreting weak messages of pain as itch. This became known as the “intensity theory”—itch is pain, below some threshold—and it became the “canonical view,” Brian Kim, a dermatologist at the Icahn School of Medicine at Mount Sinai, told me.

It never made much sense. If you catch your finger in a door, the stinging sensation does not dissipate into itch as the swelling goes down. That the body might have different circuitries for itch and pain seemed plausible for other reasons, too. “If you take 10 patients experiencing pain and give them morphine, probably all of them will feel better. If you take 10 patients with chronic itch and you give them morphine, none of them would,” Kim said. “That tells you right there.” Moreover, pain alleviates itch. It interrupts it. That is, in part, why you scratch: The pain creates the pleasure of relief. “The behavioral output is very different,” Bautista told me. “If you encounter poison ivy or get a bug bite, you don’t try to avoid the injury. You attack it. But with pain, you withdraw; you have these protective reflexes.”

Many scientists preferred an alternative theory: that itch had its own dedicated “labeled line” within the body. It took until 2007 for neuroscientists to uncover an itch-specific circuitry that many had long suspected was there. Mice genetically engineered to lack a specific receptor, scientists found, felt “thermal, mechanical, inflammatory, and neuropathic pain,” but not itch.

Since then, neuroscientists have refined and complicated their understanding of how things work—in particular, extending their understanding of what amplifies or overrides itch and the relationship between the pain and itch circuitries. And doctors have come to understand itch as a disease in and of itself.

And a curious disease, at that. In any given year, one epidemiological survey found, chronic itch afflicts 16 percent of the general adult population, making it half as common as chronic pain. Yet there are scores of American medical centers dedicated to treating pain and none for itch. On Facebook, I found hundreds of peer-support groups for people with chronic pain. For chronic itch, I found just one, dedicated to sufferers of the miserable dermatological condition prurigo nodularis.

Millions of us are scratching alone, a social reality with deep physiological roots. Itching is isolating. The touch of another person can be unbearable. When I get really itchy at night, I build a pillow wall between myself and my cuddle-enthusiast husband, so he does not accidentally wake me up, kickstart the itch-scratch cycle, and mechanically increase our chance of divorce. Studies also show that itch is both contagious and repellent. In the 1990s, scientists in Germany rigged up cameras in a lecture hall and filmed members of the public who came to watch a talk on pruritus. Inevitably, people in the crowd began scratching themselves. Yet people reflexively move away from others who are itching, and toward those in pain.

At best, scratching yourself is like chewing with your mouth open, embarrassing and undignified. At worst, it broadcasts uncleanliness, infestation, derangement, and disease, raising the specter of bedbugs, scabies, chicken pox, roseola, gonorrhea, insanity, and who knows what else. In ancient times, people believed that lice were a form of godly punishment: They generated spontaneously in a person’s flesh, tunneled their way out, and consumed their host, thus transfiguring them into bugs. Plato is one of many historical figures accused by his haters of being so lousy, literally, that it killed him. And maybe it did. An extreme lice infestation can cause a person to die from a blood infection or anemia.

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At least the ancients grasped how miserable being itchy can be. In 1365, a scabies-ridden Petrarch complained to Boccaccio that his hands could not hold a pen, as “they serve only to scratch and scrape.” In Dante’s Inferno, itching is meted out as a punishment to alchemists in the eighth ring of hell. Murderers in the seventh ring, including Attila the Hun, get a mere eternal dunk in a boiling river of blood.

In my experience, people do not meet an itchy person and grasp that they might be beyond the boiling river. (The physician and journalist Atul Gawande wrote about a patient who scratched all the way through her skull into her brain.) The stigma and the dismissal compound the body horror. When I explain that I itch, and at some point might start itching and never stop, many people respond with a nervous giggle or incredulousness. One of my dumb lines on it involves being a distant relative of a participant—to be clear, an accuser—in the Salem witch trials. Who knew that curses work so well!

Itch is a curse, an eldritch one. At night, I sometimes feel crumbs or sand on my sheets, go to brush the grit off, and find the bed clean. One day, I was rummaging around in a basement and felt a spider drop onto my shoulder from the ceiling. I felt that same, vivid sensation a hundred times more over the next few days. The inside of my body itches, like I have bug bites on my intestines and my lungs. I swear that I can feel the floss-thin electric fibers under my skin, pinging their signals back and forth.

The worst is when I need the itch to stop and I cannot get it to stop, not by dunking myself in ice water or abrading myself with a fork or stabbing myself with a needle or taking so much Benadryl that I brown out. It generates the fight-or-flight response; it feels like being trapped. I don’t know; maybe it is akin to drowning.  

My chronic itch might be a disease unto itself, but it is also a symptom. At some point in my early 30s, my immune system erred and started to destroy the cells lining the small bile ducts in my liver. This inflamed them, obstructing the flow of sticky green bile into my digestive system. The ducts are now developing lattices of scar tissue, which will spread through my liver, perhaps resulting in cirrhosis, perhaps resulting in death.

Primary biliary cholangitis is degenerative and incurable, and was until recently considered fatal. The prognosis was radically improved by the discovery that a hundred-year-old drug used to dissolve gallstones slows its progression, reducing inflammation and making bile secretion easier. But a minority of people do not respond to the medication. I am one of them.

PBC is generally slow moving. Science keeps advancing; my doctors have me on an off-label drug that seems to be working. Still, I am sick, and I always will be. I feel fine much of the time. The dissonance is weird, as is the disease. What am I supposed to do with the knowledge of my illness? Am I at the end of the healthy part of my life, at the beginning of the dying part?

I am stuck with questions I cannot answer, trying to ignore them, all the while reminded of them over and over again, itchy.

Some answers, however, are coming. Having found nerve circuits dedicated to itch, scientists also began finding receptors triggered by substances other than histamine, thus unlocking the secrets of chronic itch. “We know more about the neural circuits that allow you to experience this sensation, regardless of cause,” Bautista told me. “We know more about inflammatory mediators and how they activate the circuits. We know more about triggers and priming the immune system and priming the nervous system.”

I asked a number of experts to help me understand chronic itch in the same way I understood acute itch—to show me an itch map. “It’s complicated,” Kwatra told me. “Complicated,” Kim agreed. “Complex,” said Xinzhong Dong of Johns Hopkins. The issue is that there’s not really a map for chronic itch. There are multiple itch maps, many body circuits going haywire in many ways.

Still, Dong gave me one example. The drug chloroquine “works really well to kill malaria,” he explained. But chloroquine can cause extreme itchiness in people with dark skin tones. “The phenomenon is not an allergic reaction,” Dong told me; and antihistamines do not ease it. In 2009, his lab figured it out: In highly simplified terms, melanin holds chloroquine in the skin, and chloroquine lights up an itch receptor.

Because there is no single map for chronic itch, there is no “big itch switch that you can turn off reliably with a drug,” Kim told me. “I’m not so convinced that it is even doable.” (Dong thought that it probably is. It just might cause debilitating side effects or even kill the itchy person in the process.) Still, there are lots of smaller itch switches, and researchers are figuring out how to flip them, one by one.

These include a pair of cytokines called interleukin 4 and interleukin 13. When a person encounters an allergen, the body secretes these chemical messengers to rev up the immune system. Yet the messengers also spur the body to produce itch-related cytokines and make the nervous system more sensitive to them. In 2017, the FDA approved a drug called Dupixent, which blocks the pair of cytokines, to treat atopic dermatitis, a form of eczema; the agency later approved it for asthma, laryngitis, and other inflammatory conditions (at a retail cost of $59,000 a year).

Michael McDaniel found a single open blister on his bicep when he was traveling in Europe in 2013. Within a few days, he told me, a crackling, bleeding rash had engulfed his upper extremities, oozing a honey-colored liquid. His knuckles were so swollen that his hands stiffened.

Back in the United States one miserable week after his trip, he saw a dermatologist, who diagnosed him with atopic dermatitis. Nothing McDaniel tried—steroids, bathing in diluted bleach, avoiding cigarette smoke and dryer sheets, praying to any god who would listen—ended his misery. He bled through socks and shirts. He hid his hands in photographs. “I was able to get my symptoms to a manageable baseline,” he told me. “It wasn’t really manageable, though. I just got used to it.”

McDaniel muddled through this circle of hell for seven years, until his dermatologist gave him an infusion of Dupixent. Twenty-four hours later, “my skin was the calmest it had been since my symptoms appeared,” McDaniel told me. The drug was a “miracle.”

Numerous drugs similar to Dupixent have been found over the past seven years to work on chronic itch, and physicians are refining techniques such as nerve blocks and ketamine infusions. But finding treatments for itching that is not related to an immune response has proved harder. Progress is throttled by the relatively small number of researchers working on itch, and the limited sums Big Pharma is willing to pump into drug development and trials. Plus, treatment options do not readily translate into treatment; a lot of folks are still being told to try Benadryl, even if all it does is make them groggy.

When I saw my hepatologist in August, that’s exactly what he suggested. The drug would help to quell the itching caused by my scratching, at a minimum, and help me sleep.

“I hate Benadryl,” I snapped. (Maybe I need a new T-shirt.) He suggested Zyrtec or Claritin.

As I continued to press for more options, he reviewed my bloodwork. My liver enzymes were still high. He suggested more tests, a biopsy. And he said we could start trialing drugs to manage my symptoms better. SSRIs, used to treat depression, sometimes ease itch in patients with PBC. Opioid antagonists, used to treat heroin overdoses, sometimes do the same. Cholestyramine, which soaks up bile acid (a known pruritogen), could work. Maybe UVB phototherapy. Maybe a cream charged with fatty acids that activate the endocannabinoid system. Maybe rifampin, an antibiotic.  

These ragtag off-label treatment options reflect the fact that physicians have not yet figured out PBC’s itch map. Some patients just itch and itch and itch and it never ends. I once asked my old hepatologist what she would do if that happened to me. “Transplant your liver,” she told me, not even looking up from her computer.

This was not a comforting answer. Organ transplantation is a lifesaving miracle, but a saved life is not an easy one. Recovery from a liver transplant takes at least a year. Grafts die, not infrequently. Many patients never heal fully. The five-year survival rate is 14 percentage points lower for PBC patients with liver transplants than it is for PBC patients who respond to the standard treatment and do not need one.

When I shared this prognosis with my mother, she responded, “You better start being nice to your siblings!” (I would rather die.) When I broke it to my husband, he paused a beat before saying he might go call his therapist.

Would I rather just live with the itch? How would I do it? I could not find a support group for the chronically itchy. But I did find two people with PBC who were willing to share their experiences with me. Carol Davis is a retired kindergarten teacher. More than a decade ago, she started itching “like crazy,” she told me. “It would wake me up in the night.” A doctor diagnosed her with PBC; like me, she itches on and off, and doctors have never found a set of drugs to quell her itch without causing miserable side effects.

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I asked her how she has dealt with it, not in terms of doctors and drugs and lotions but in a more cosmic sense. “When you’re at the end of your lifespan, you just have the mindset: These things are going to happen,” Davis told me. “If I had been younger, like you, it might have been more scary.” Then she ticked off a list of things she looks forward to: games of Farkle, Bible study, going to the gym, seeing her friends from her sorority, spending time with her husband of 54 years. She got out of her head, she meant. And when she found herself back there, itching or afraid or in pain, she told me, “I don’t dwell on myself. I don’t ask the Lord to make me well. I dwell on Him!”

Gail Fisher is 84 “and a half,” she told me, and a harpist, gardener, and motor-home enthusiast. She lives alone in rural Effingham County, Illinois. Her PBC has developed into cirrhosis, and she also has arthritis and thyroid disease. The itching drives her nuts sometimes too, she told me. But she does not dwell on it either. “Gosh, don’t worry about it,” she said. “You don’t know what tomorrow is going to bring anyway!”  

When the itch is at its worst—not a bodily sensation but an existential blight, not a force begging for resignation but one driving a person to madness—that’s easier said than done. Still, I knew that following Davis’s and Fisher’s advice would do me more good than lotion or Benadryl ever has.

I’m here, my body tells me. I’m here. I’m alive. I’m dying. I’m here.

I know, I respond. Enough. I know.