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.

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

Until the very end of his presidency, Donald Trump’s cultivation of the Proud Boys, the Oath Keepers, and other violent far-right groups was usually implicit. He counted on their political support but stopped short of asking them to do anything.

Trump had mastered a form of radicalization sometimes known as stochastic terrorism—riling up followers in ways that made bloodshed likely while preserving plausible deniability on his part.

But in the weeks after November 3, 2020, his language became more direct. He named the place and occasion for a “big protest”—on January 6, 2021, when Congress would be certifying his election loss—and told supporters, “Be there, will be wild!” When that day arrived, Trump told the assembled crowd, “If you don’t fight like hell, you’re not going to have a country anymore.” With that, the president of the United States embraced violence as the natural extension of Americans’ democratic differences, and he has not stopped since.

Trump continues to lash out at his perceived enemies. Yet Americans have mostly been able to treat Trump’s extremism as background noise. That’s partly because he’s no longer in office, and partly because he’s no longer using Twitter. But it’s also because the legal counteroffensive against pro-Trump extremism, along with a proliferation of court proceedings holding Trump himself to task for his misdeeds, appears to have given his fans reason to think twice before committing crimes on his behalf.

[From the November 2020 issue: A pro-Trump militant group has recruited thousands of police, soldiers, and veterans]

Extremism ebbs and flows. Violent groups can grow only when they can raise money and recruit members faster than law enforcement can shut down their operations. They thrive when they are perceived to be winning; even the kind of person who might be drawn to violence makes a calculation about whether taking part in a plot to, say, overthrow an election or kidnap the governor of Michigan will be worth the risk. In the past few years, Trump’s election loss and his legal woes have made him less persuasive in this regard.

Trump now faces both state and federal conspiracy charges for his efforts to stay in power despite losing the election. Leaders of the Proud Boys and Oath Keepers have received long prison sentences for their role in the violence of January 6. Fox News, which knowingly broadcast false statements about faulty voting machines rather than offend its pro-Trump core audience, agreed to a defamation settlement of nearly $800 million with Dominion Voting Systems. All of these proceedings have demonstrated that Trump and his supporters will be held accountable for what they do and say.

But if Trump wins another term, both he and his most disreputable supporters will feel vindicated. The Republican Party has already given Trump a pass for exhorting a mob to break into the Capitol. In turn, Trump has promised to pardon many of the January 6 insurrectionists. His forgiveness could extend to extremist leaders convicted on federal charges.

Federalism, to be sure, would be a check on his power. Trump’s followers, like Trump himself, may still be subject to state prosecution. But a president with firm control of the Justice Department, who wields a corps of supporters willing to use intimidation for political ends and who has maintained a considerable following among police, could overwhelm the ability of state institutions to uphold the law.

[From the January/February 2024 issue: Barton Gellman on how Trump gets away with it]

Trump’s bullying of military leaders, journalists, and judges was never merely the ranting of an attention seeker, and that behavior—backed by the credible threat of violence from radicalized supporters—will likely become even more central to his governing style. “The extremism won’t be some side group,” Erica Chenoweth, a Harvard professor who studies political violence, told me. “It won’t be like a terror group against the state. The conditions will be different. It will be embedded into state institutions, and into the orientation of the state against perceived opponents.”

What’s clear is that a restored Trump would have a winning narrative in which right-wing extremism, after suffering some legal setbacks during the Biden interregnum, thrives again.

This article appears in the January/February 2024 print edition with the headline “Extremists Emboldened.”