Editor’s Note: This article is part of “If Trump Wins,” a project considering what Donald Trump might do if reelected in 2024.

There were times, during the first two years of the Biden presidency, when I came close to forgetting about it all: the taunts and the provocations; the incitements and the resentments; the disorchestrated reasoning; the verbal incontinence; the press conferences fueled by megalomania, vengeance, and a soupçon of hydroxychloroquine. I forgot, almost, that we’d had a man in the White House who governed by tweet. I forgot that the news cycle had shrunk down to microseconds. I forgot, even, that we’d had a president with a personality so disordered and a mind so dysregulated (this being a central irony, that our nation’s top executive had zero executive function) that the generals around him had to choose between carrying out presidential orders and upholding the Constitution.

I forgot, in short, that I’d spent nearly five years scanning the veldt for threats, indulging in the most neurotic form of magical thinking, convinced that my monitoring of Twitter alone was what stood between Trump and national ruin, just as Erica Jong believed that her concentration and vigilance were what kept her flight from plunging into the sea.

Say what you want about Joe Biden: He’s allowed us to go days at a time without remembering he’s there.

[Adam Serwer: An incompetent authoritarian is still a catastrophe]

But now here we are, faced with the prospect of a Trump restoration. We’ve already seen the cruelty and chaos that having a malignant narcissist in the Oval Office entails. What will happen to the American psyche if he wins again? What will happen if we have to live in fight-or-flight mode for four more years, and possibly far beyond?

Our bodies are not designed to handle chronic stress. Neuroscientists have a term for the tipping-point moment when we capitulate to it—allostatic overload—and the result is almost always sickness in one form or another, whether it’s a mood disorder, substance abuse, heart disease, type 2 diabetes, or ulcers. “Increase your blood pressure for a few minutes to evade a lion—a good thing,” Robert Sapolsky, one of the country’s most esteemed researchers of stress, emailed me when I asked him about Trump’s effect on our bodies. But “increase your blood pressure every time you’re in the vicinity of the alpha male—you begin to get cardiovascular disease.” Excess levels of the stress hormone cortisol for extended periods is terrible for the human body; it hurts the immune system in ways that, among other things, can lead to worse outcomes for COVID and other diseases. (One 2019 study, published in JAMA Network Open, reported that Trump’s election to the White House correlated with a spike in premature births among Latina women.)

Another major component of our allostatic overload, notes Gloria Mark, the author of Attention Span, would be “technostress,” in this case brought on by the obsessive checking of—and interruptions from, and passing around of—news, which Trump made with destructive rapidity. Human brains are not designed to handle such a helter-skelter onslaught; effective multitasking, according to Mark, is in fact a complete myth (there’s always a cost to our productivity). Yet we are once again facing a news cycle that will shove our attention—as well as our output, our nerves, our sanity—through a Cuisinart.

[Read: ‘This is fine,’ the meme that defined a decade]

One might reasonably ask how many Americans will truly care about the constant churn of chaos, given how many of us still walk around in a fug of political apathy. Quite a few, apparently. The American Psychological Association’s annual stress survey, conducted by the Harris Poll, found that 68 percent of Americans reported that the 2020 election was a significant source of strain. Kevin B. Smith, a political-science professor at the University of Nebraska at Lincoln, found that about 40 percent of American adults identified politics as “a significant source of stress in their lives,” based on YouGov surveys he commissioned in 2017 and 2020. Even more remarkably, Smith found that about 5 percent reported having had suicidal thoughts because of our politics.

Richard A. Friedman, a clinical psychiatry professor at Weill Cornell Medical College, wonders if a second Trump term would be like a second, paralyzing blow in boxing, translating into “learned helplessness on a population-level scale,” in which a substantial proportion of us curdle into listlessness and despair. Such an epidemic would be terrible, especially for the young; we’d have a generation of nihilists on our hands, with all future efforts to #Resist potentially melting under the waffle iron of its own hashtag.

Which is what a would-be totalitarian wants—a republic of the indifferent.

Ironically, were Trump to win, an important group of his supporters would bear a particular psychological burden of their own, and that’s our elected GOP officials. I’ve written before that Trump’s presidency sometimes seemed like an extended Milgram experiment, with Republican politicians subjected to more and more horrifying requests. During round two, they’d be asked to do far worse, and live in even greater terror of his base—and even greater terror of him, as he tells them, in the manner of all malignant narcissists, that they’d be nothing without him. And he wouldn’t be wholly wrong.

The Trump base, however, will be intoxicated. We should brace ourselves for a second uncorking of what Philip Roth called “the indigenous American berserk”: The Proud Boys will be prouder; the Alex Jones conspiracists will let their false-flag freakishness fly; the “Great Replacement” theorists will become more savage in their rhetoric about Black, Hispanic, and Jewish people. (The Trump administration coincided with a measurable increase in hate crimes, incited in no small part by the man himself.)

[From the January/February 2024 issue: The Proud Boys love a winner]

But at this point, even an electoral defeat for Trump might not significantly diminish the toll that politics is taking on the collective American psyche. “In such a polarized society, everyone is always living with a lot of hate and fear and suspicion,” Rebecca Saxe, a neuroscientist at MIT who thinks a good deal about tribalism, told me. The winner of the presidential election “may change who bears the burden every four or eight years, but not the burden itself.”

Of course, fractured attention, heightened anxiety, and moral cynicism may come to seem like picayune problems if Trump wins and some 250 years of constitutional norms and rules unravel before our eyes, or we’re in a nuclear war with China, or the former chairman of the Joint Chiefs of Staff is frog-marched off to court for treason.

“You get Trump once, it’s a misfortune,” Masha Gessen, the author of Surviving Autocracy, told me. “You get him twice, it’s normal. It’s what this country is.”

This article appears in the January/February 2024 print edition with the headline “The Psychic Toll.” When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

Brilliant, witty, and ambitious, Henry Kissinger made diplomacy the stuff of unrivaled celebrity. He thrived on attention, and would have been thrilled by  the flood of coverage that marked his death last week. Whether the obituaries and commentaries put his record in a positive or negative light, almost all of them treated Kissinger as the master of events.

This may be how he wanted to be remembered, but it’s not what really happened. No matter how often Kissinger is described as the Cold War’s most powerful secretary of state and a peerless elder statesman, the truth is that his tenure was often rocky, as full of setbacks as acclaim. By the time he left government, he was viewed by many of his colleagues as a burden, not an asset. Once out of office, the advice he gave his successors was sometimes spectacularly wrong, and frequently ignored.

In President Richard Nixon’s first term, Kissinger presided over three big diplomatic transformations—withdrawal from Vietnam, the opening to China, and détente with the Soviet Union. When he became secretary of state, his policy dominance was virtually unchallenged.  He was the first (and, to this day, only) person ever to run the State Department while serving simultaneously as the president’s national security adviser. Outside of government, he enjoyed unprecedented global renown. Less than a month after his Senate confirmation, he won the Nobel Peace Prize.

[Shan Wang: Henry Kissinger’s real legacy]

Yet when Kissinger left office barely three years later, most of his ambitious schemes were unrealized. Others had simply been rejected. On the left, many revile Kissinger for the human costs of the policies he pursued; on the right, some still admire his unsentimental use of military force. In fact, the real story of Kissinger’s tenure as secretary of state is a tale in which, again and again, he encountered the limits of his power, and found himself unable to impose his will.

The policies Kissinger developed largely in secret to help wind down the Vietnam War enjoyed far less support once the war was over and they were subjected to more normal, open debate. His influence ebbed steadily. In 1975, Gerald Ford, who had succeeded Nixon a year earlier, forced Kissinger to give up the national-security job. Ford created further checks on Kissinger’s power by picking two former congressional colleagues, Donald Rumsfeld and George H. W. Bush, as secretary of defense and CIA director, respectively. Congress itself voted into law a series of challenges to Kissinger’s policies, something it had consistently failed to do under Nixon. Perhaps worst of all, the secretary of state bore some of the blame for Ford’s defeat in the 1976 election. The president’s campaign managers told reporters they saw him as a vulnerability. So did Ronald Reagan, whose bid for the Republican nomination centered in part on a promise to fire Kissinger.

Kissinger’s lost dominance was especially pronounced in what was arguably the central arena of his policy: the stable relationship—known as “détente”—that he sought to establish with the Soviet Union. His problems began with arms control. In November 1974, soon after Ford became president, Kissinger arranged a quick summit with the Soviet leader Leonid Brezhnev, hoping for a breakthrough in negotiating a long-term treaty to limit each side’s strategic nuclear forces. But he was never able to turn the framework they agreed on into a real treaty. One obstacle was a congressional requirement that U.S. and Soviet forces be equal—at a time when Soviet missiles were getting steadily bigger and more numerous. Outside experts claimed that Kissinger’s framework couldn’t meet that test. Writing in Foreign Affairs, Paul Nitze—a senior national-security official under Harry Truman, John F. Kennedy, and Lyndon B. Johnson—insisted it would give Soviet forces a three-to-one advantage. (Privately, Nitze was far angrier, calling the secretary of state a “traitor to his country.”)

Even harder for Kissinger to handle was opposition within Ford’s inner circle. Rumsfeld, once he became defense secretary, was ready to take disagreements with Kissinger right into the Oval Office, telling the president that the United States had been losing its nuclear edge for a decade. At the CIA, Bush approved an assessment largely endorsing Nitze’s critique. Outside the administration, Reagan echoed the same charges. No surprise, then, that Ford eventually put the talks aside.

Kissinger found the ideological dimension of Soviet-American relations still more vexing. He had promised Soviet leaders to expand trade ties by granting Moscow “Most Favored Nation” tariff status, but he could not manage congressional demands for freer emigration from the Soviet Union. The initiative collapsed, but not before senior figures in both Congress and the Kremlin concluded that Kissinger had been deceiving them. On human rights more generally, the secretary of state was isolated within his own administration. He did persuade the president not to meet with Aleksandr Solzhenitsyn, the most famous and outspoken Soviet dissident, but three other members of the Ford Cabinet defied him and conspicuously attended an AFL-CIO dinner in Solzhenitsyn’s honor. Even the young Dick Cheney, then the deputy White House chief of staff, dissented: Détente, he argued, didn’t have to be all “sweetness and light.”

[Gary J. Bass: The people who didn’t matter to Henry Kissinger]

Learning little from this opposition, Kissinger continued to hurt himself with scarcely concealed disdain for opponents of the Soviet regime. (“You know,” he once joked, “what would have happened to them under Stalin.”) The impact reached well beyond Washington. When Reagan delegates to the 1976 Republican convention wanted to repudiate Kissinger, they drafted a platform plank titled “Morality in Foreign Policy.” Ford and his advisers—who had already banned official use of the word détente—felt they had to allow it to pass.

Apart from arms control and human rights, Kissinger also had trouble imposing his views on Soviet-American competition in the Third World. When he wanted to launch a covert program to arm rebels against Moscow’s client regime in Angola, news quickly leaked to The New York Times. Congressional Democrats, predictably, voted to block the weapons transfer altogether. Less predictably, many Republican senators—liberals, moderates, and conservatives alike—also joined in, giving the measure a two-to-one majority. The president’s own party was deserting its celebrity diplomat.

Kissinger was furious, just as he had been earlier in 1975 when, with the fall of Saigon approaching, he proposed a big increase in arms supplies for South Vietnam. To make it happen, however, congressional approval was necessary—and again wanting. Ford ultimately chose not to fight the issue. Instead, in a speech at Tulane University, he declared the war “finished as far as America is concerned.” The White House did not even let Kissinger know that the game-over announcement was coming.

Much of the commentary on Kissinger’s career has presented him as the embodiment of unchecked presidential power over foreign policy. But the pushback against his policies grew steadily stronger as their downsides became better known. In the 1970s, Congress became far more assertive on foreign policy, legislating issues including arms control, human rights, foreign military sales, and covert action. Kissinger frequently railed against the decade-long decline in national-security budgets, but this too was part of his legacy. So were other institutional reforms, such as the Carter administration’s creation of a human-rights bureau in the State Department and the annual publication of global-human-rights reports. Other forms of pushback were less foreseeable: The “most powerful secretary of state in the post-World War II era” surely never imagined what Jimmy Carter’s high-profile envoy to China—Leonard Woodcock, the former head of the United Auto Workers—would tell his Beijing staff at their first meeting: “Never again shall we embarrass ourselves before a foreign nation the way Henry Kissinger did with the Chinese.”

After he left office, Kissinger kept much of the advice he gave his successors confidential, probably thinking that a little mystery about the extent of his influence would only help his new consulting business. But enough is known about some of his Oval Office meetings to challenge the common picture of presidents and advisers listening reverently while Henry Kissinger shared his wisdom. Kissinger’s sustained effort to reorient Reagan’s policies toward the Soviet Union provides a striking example. Together with Nixon, he argued that Mikhail Gorbachev was cynically exploiting the president’s naive antinuclear sentiments so as to tear apart the Western alliance. Under perestroika, they argued, the Soviet threat was actually increasing, not diminishing. Reagan ignored them—and over time harvested a global Soviet foreign-policy retreat.

Kissinger’s shortfalls in office and after are not the whole story, of course. In his first weeks as secretary of state, he was plunged into a crisis—Egypt’s surprise Yom Kippur attack on Israel, followed by the OPEC oil embargo. The cease-fire and disengagement agreements he negotiated bolstered American influence in the Middle East, a region to which he had paid little previous attention. He seemed, to quote the title of my colleague Martin Indyk’s recent book, the “master of the game.”

Yet here, too, the master’s record seems ripe for reassessment—and not just for his early, forgivable missteps. At the start of the Yom Kippur war, Kissinger thought it might be best to keep a low profile and meet Israel’s needs indirectly, by contracting with private companies to deliver arms. Nixon ordered his celebrity policy maker to stop dithering and organize a U.S. airlift. “Do it now!” he barked. More serious is the charge that, even at the height of his power, Kissinger had, of all things, a too-limited conception of what diplomacy could achieve. The most it should try to accomplish, he felt, was to stabilize the world, not to alter—much less transform—it. Hence, the secretary of state was reluctant to take on the hardest parts of the Middle East puzzle—above all, the clash between Israelis and Palestinians, still atop the headlines half a century later.

[From the December 2016 issue: The lessons of Henry Kissinger]

Indyk traces Kissinger’s hesitation to the same sources others have cited: his conservative view of history, his immersion as a scholar in the diplomacy of 19th-century Europe, and his personal experience of 20th-century totalitarianism. All of these drove home the value of stability. But, in looking to explain this conception of diplomacy, we should not leave out what Kissinger surely learned from his own bumpy record as secretary of state. No matter what the tributes and obituaries say, every day on the job confirmed the limits of his power, the difficulty of overcoming them, and his ability to make mistakes when he tried to do so.