If a general election were held tomorrow, 25 percent of British voters would choose Reform, YouGov poll suggests.

The 28-year-old from Dorset was evacuating people from a town on the front line when his vehicle was hit.

To understand the harm Donald Trump has done with his tariffs on Canada and Mexico, here are four things you need to know:

First, every tax on imports is also a tax on exports.

The most popular beer in America is Modelo Especial, brewed in Mexico. Impose a 25 percent tariff on Modelo and sales will slide. So, too, will exports of the American barley that goes into Mexican beer. Mexico buys three-quarters of U.S. barley exports, almost all for brewing.

Trump surrogates may promise you that by driving Mexican beer off of grocery shelves, Trump’s tariffs will increase sales of U.S. barley to U.S. brewers. That promise may even be substantially true. But that offer has fine print that barley growers will notice.

Barley growers don’t care only about how much barley they sell. They care about the price at which they sell it.

A tariff raises the price of both every imported good and every good that competes with imports. If the price of Modelo is pushed up, the price of American-brewed beer will rise as well. American beermakers are not operating a charity. The tariff on Modelo allows them to both increase their market share at Modelo’s expense and raise their prices enough to increase their margins at the consumers’ expense.

But American consumers do not have infinite amounts of money. If they are paying more for beer, they have to make savings elsewhere. The result—and economists will prove this to you all day with facts and figures—is that prices in exporting sectors such as barley, and agriculture generally, will decline in proportion as prices in the importing sectors rise.

This is why developing countries that tried, after 1945, to bulldoze their way to industrialization using high tariffs—Argentina under Juan Perón; India under Jawaharlal Nehru—ended up instead isolating themselves from world markets. The tariffs did allow them to make their own radio sets and cars, but at the price of lowering national incomes and so shrinking the domestic market for those radios and cars. And, of course, the protected radios and cars could not compete on global markets against the superior products of the countries that accepted world prices, such as Germany and Japan.

Trump tariffs will be paid in the form of higher prices for imports and their substitutes, and lower profits and wages for everyone who works in export industries.

[Juliette Kayyem: Trump is threatening California in the wrong way]

Second, every product is also an input.

When journalists write about tariffs, they look for everyday examples familiar to everyone, the way I just did with Modelo beer. Others will cite tomatoes or avocados, food items for which the cost of the tariff will be reflected in the price at the supermarket checkout. But the greatest harm done by tariffs is concealed in a way that prevents most of us from seeing the harm directly.

The largest glassmaker in North America is a Mexican company, Vitro. It operates plants in the U.S. and Canada, but the center of its operations is Monterrey, Mexico.

Very few of us buy big sheets of industrial glass. We do not see or care about the price. But we do care about the price of a new apartment. That apartment price depends on the cost of construction. Which depends on the price of the window systems that clad the apartment building. Which depends on the price of glass. Which Trump just raised by up to 25 percent.

You may buy a little aluminum in the form of cans and other household products. But the main way you pay for aluminum is in the price of airline tickets. Put a tariff on aluminum, and aircraft prices rise. Inflate aircraft prices, and airline-ticket prices also rise. The traveler will not know why, and will be tempted to blame airline greed—and will find politicians ready to feed that grievance. Who will connect the surprise extra fee they have to pay to sit beside their child with a president’s decree against the cheaper Canadian aluminum that owes its price advantage to superabundant Quebec hydroelectric power?

Big, sophisticated global companies can shift their input-sourcing from tariffed countries such as China and Mexico to favored countries such as Vietnam and the Philippines. But the shift is never easy. For smaller companies, it may prove altogether unfeasible. The largest maker of outboard motors in the United States employs only about 5,000 people. It is furloughing and laying off more than a quarter of its workforce. This type of firm cannot easily fly into Hanoi to source a reliable replacement for its trusted components supplier in Shenzhen, China. The challenge is only greater when the U.S. manufacturer has no idea how long the Trump tariffs will last. It will probably continue to use its familiar suppliers, pay the tariff, raise its prices, and suffer the stagnation and shrinkage of its business.

[Read: Democrats wonder where their leaders are]

Third, “illegal” is irrelevant; don’t expect relief from tariffs through lawsuits.

You might wonder how can Trump do this. After all, Trump himself renegotiated NAFTA and praised his new U.S.-Mexico-Canada trade deal as “based on the principle of fairness and reciprocity.” Surely, it can’t possibly be consistent with U.S. treaty obligations to impose new tariffs on a whim.

All true. Trump’s actions are almost certainly illegal under treaty rules. But the U.S. stopped obeying treaty rules some time back.

In 2018, the Trump administration imposed tariffs on steel and aluminum imports. The affected countries took their case to the World Trade Organization. More than four years later, in December 2022, the WTO issued its judgment. The United States lost on every point. Result? The Biden administration declared it would ignore the ruling. The United States “will not cede decision-making over its essential security to WTO panels,” said a spokesperson for then–U.S. Trade Representative Katherine Tai.

Those defiant words were backed by obstructionist practices. In 2017, the Trump administration had blocked new appointments to the WTO’s appellate court, in effect the supreme court of world trade. The Biden administration continued the embargo. Today, all seven seats on the panel are empty.

The United States has likewise sabotaged the dispute-settlement mechanisms under the North American trade agreements. In 1998, the U.S. escaped defeat on a Mexican complaint by the ingenious method of refusing to appoint anyone to the commission that was supposed to adjudicate the matter. That more or less killed NAFTA from the start as a way to police actions by the American government. Trump’s U.S.-Mexico-Canada trade agreement is even more riddled with exceptions that allow his government to do as it pleases.

On trade, the U.S. itself has led the way back to the law of the jungle. Remember that fact when the other big cats strike back.

[Read: Trump has created health-care chaos]

Fourth, Americans may not remember their past actions, but others do.

You may have already forgotten all about last weekend’s Trump outburst against Colombia, backed by threats of high tariffs on Colombian products. You may not ever have known that Colombia opened up to U.S. wheat, soybean, beef, cotton, and peanut exports in order to secure a free-trade agreement with the United States. But Colombians remember.

Colombia’s politics are intensely polarized, the legacy of bitter years of insurgency and civil war. Through most of the 21st century, Colombia’s politics had been dominated by U.S.-friendly politicians of the right. In 2022, for the first time in its modern history, Colombia elected a president of the left, Gustavo Petro. Petro is a former Marxist guerrilla, but he pledged to continue dialogue with the United States.

How does that dialogue look now to Colombians? And to others in South America and the world?

Trump is single-handedly reneging on 80 years of American work to persuade others to trust and rely on the United States. He is remodeling the international image of the U.S. after himself: impulsive, self-seeking, short-sighted, and untrustworthy. First-term Trump might have been dismissed as an aberration, brought to office by a fluke of America’s archaic Electoral College. A returned Trump, this time empowered by a genuine popular-vote victory, cannot be so readily dismissed. He obviously represents something deep in American politics, something likely enduring, something that other countries must take into account.

Mexico and Canada must ultimately suffer whatever the U.S. imposes on them. They cannot relocate; they have few credible options. Mexico has learned from especially bitter experience that any attempt to strike its own international deals will be vetoed by the U.S., using force if necessary.

Canadians have had an easier time, summed up by the cynical local joke: “The Americans are our best friends whether we like it or not.” But other countries have more options.

[From the March 2025 issue: Europe’s Elon Musk problem]

Over the past five centuries, the Euro-Atlantic world has seen the rise of one great power after another: Habsburg Spain, Bourbon and Napoleonic France, Victorian Britain, Imperial and then Nazi Germany, the Soviet Union. Each of those powers was ultimately brought down because it frightened other powers into uniting against it.

The United States since 1945 tried a different way. It reconciled the world to its dominance in great part by using that dominance for the benefit of willing partners. The United States provided security, it opened markets, it welcomed the improving prosperity of fellow democracies and like-minded allies. Who would hazard the costs and dangers of uniting to topple such a benign hegemon—at least, so long as the hegemon remained benign?

In the 21st century, the United States faces a new kind of adversary. Past rivals might have matched the U.S. in wealth, technology, or military strength, but not in all three. China today is the nearest peer power the U.S. has faced since Americans battled the British Empire in the War of 1812. To balance China while keeping the peace, the U.S. will need more and better friends than ever before. Trump is doing his utmost instead to alienate and offend those friends.

“America First” means “America Alone.” This week’s trade wars are steps on the way to future difficulties—and, unless a great infusion of better judgment or better luck suddenly occurs, future disasters.

The geopolitical verdict on the first Trump presidency could be written with a breath of relief: “Bad as it was, it could have been worse.” On the present trajectory, the verdict on the second may not come with any relief at all.

“That’s what’s great about being a writer,” Hanif Kureishi told an interviewer a decade ago. “Every 10 years you become somebody else.” He was 59 then, looking back on his younger days; in his 30s, he’d made his mark on a newly multicultural literary scene in London with the Oscar-nominated screenplay for My Beautiful Laundrette, followed by the prizewinning debut novel The Buddha of Suburbia. The son of an English mother and a Pakistani father, he was a bad boy in the spotlight, intimate with working-class locals and worldly elites, unabashed about smoking weed and sleeping around, and funny. He invoked P. G. Wodehouse and Philip Roth, and struck a chord with upstart young readers and writers (among them Zadie Smith). His boldly nonconformist voice was his own.

Then, at the age of 68, in December 2022, he became somebody unimaginably different after he keeled over onto a hard floor in Rome and came to consciousness a paraplegic. Trapped in a paralyzed body in a hospital bed, he tweeted two weeks later, via his son: “An insect, a hero, a ghost or Frankenstein’s monster. Out of these mixings will come magnificent horrors and amazements. Every day when I dictate these thoughts, I open what is left of my broken body in order to try and reach you, to stop myself from dying inside.” And suddenly, Kureishi was back in the spotlight. People around the world were listening. He kept dictating.

When I went to visit him in London two years later, this past December, he was in his power chair, in the ground-floor living room of his colorful, cluttered house in Shepherd’s Bush. His hospital bed is in one corner, with stacks of books he cannot reach packing the shelves above it; his partner, Isabella d’Amico, and his 24-hour health aide, Kamila, sleep in bedrooms upstairs, next to his large, now-unused study. He had been sick with diverticulitis and had smoked half a joint and drunk half a beer, he told me, on the fateful day when he fainted and “fell literally flat on my face. Bang. Without putting my arms out or anything. I fell flat on my fucking face and broke my neck.” While we talked, his right hand, in splints to keep it from clawing up, fluttered in front of him, almost as if it were strumming a guitar—ironic, because Kureishi used to passably play the blues. His mobility is limited to controlling his chair, leaning forward, and wiggling his hips. Drugs, now a cocktail of pharmaceuticals, are very much back in his life: He’s taking 12 or so a day; he isn’t really sure. “It’s to make me shit. It’s to stop my bladder doing this. It’s for this, that, the other. God knows.”

He went cold turkey on virtually everything else, compelled by another need. Right away, he was “mad to fucking write,” he told me. “And I still am mad to write. It’s holding me together.” At first, the fragmented, dispatch-like nature of Twitter gave his individual utterances a suspenseful intensity: “Sitting here again in this dreary room for another week, like a Beckettian chattering mouth, all I can do is speak, but I can also listen,” he tweeted a few days into his new life. And then, “I wouldn’t advice [sic] having an accident like mine, but I would say that lying completely inert and silent in a drab room, without much distraction, is certainly good for creativity.”

[Read: Hanif Kureishi is tweeting for his life]

Two weeks after the accident, Carlo, one of his three sons, revived the dormant Substack, The Kureishi Chronicles, that his father had once launched. The dictations began to coalesce into essays that combined tales of his former, able-bodied life with unvarnished assessments of his medical and mental conditions. “Experiencing the press coverage you might receive had you died,” in his words, spurred him on, and in July, just after he moved from an Italian rehab facility to London’s Chelsea and Westminster Hospital, his agent agreed that the entries would work as a book. Shattered, a bare, tumultuous memoir of the first year of Kureishi’s new life, published in the United Kingdom in October 2024, is now out in the United States. It’s simultaneously the story of his mind’s entrapment in his body and his attempt to outrun that restriction with radical transparency.

Back in the 2014 interview, he’d spoken of forging “a new kind of English realism” as his career took off. After reading Shattered, I wondered if the multigenre experimenter had, quite literally, stumbled into a new kind of illness realism.

Nobody is equipped for the kind of calamity that struck Kureishi. But the body, with all its spewing, writhing, lusting, hunger, and degradation, had long been his obsession. His fiction had traced his own arc from young renegade to disgruntled middle-aged father to ailing older man. Pain and pleasure were his recurring catharsis points. He wanted to explore whether, and how, the body could really satisfy the curiosities of the mind.

My Beautiful Laundrette is bookended by two beatings similar to ones inflicted on an adolescent Kureishi by punks who regularly chased him home from school. Pain conveys its bearer, whether it’s the Pakistani British Omar or his former skinhead lover, Johnny, to a new level of self-realization. The Buddha of Suburbia—with more plotlines pulled from Kureishi’s young life—follows teenage Karim on lust- and creativity-fueled escapades that end with the kind of sex that includes a leather hood, ropes, and a candle inside an orifice. “What do you do?” he asks the woman involved in this act. “Pain as play,” she responds. “A deep human love of pain. There is desire for pain, yes?” In the wincingly autobiographical novel Intimacy (1998), a married man who leaves his wife for another woman has aging very much on the brain.

But The Body (2002) most uncannily foreshadowed Kureishi’s current situation. The novel is narrated by a writer in his mid-60s whose medical ailments have left him broken—“I don’t go to parties,” he moans, “because I don’t like to stand up.” But a secretive new surgery transplants his brain into a young, fit body for six months, which he uses to screw women across Europe, take ecstasy, and contemplate how experiencing a body’s failure elevates your appreciation of just how good you can feel. “After the purifications and substitutions of culture,” he thinks, “I believed I was returning to something neglected: fundamental physical pleasure, the ecstasy of the body, of my skin, of movement, and of accelerated, spontaneous affection for others in the same state.”

Anointed with unexpected establishment credentials (Queen Elizabeth II named him a Commander of the Order of the British Empire in 2008), Kureishi was mellowing in the 2010s. As he put it to me, “I was bored with my own imagination and … I was happy having a good life. I was living part of the time in Italy, part of the time here; the kids were grown up. So I thought, Fuck it. Why should I spend all day working? So I was taking it easy and I had—I didn’t have much of a desire to write anymore. Not with the enthusiasm I had when I was younger. Then I had the accident.”

Writing fiction no longer merely strikes him as boring. To “make up shit” has become impossible. “It just seems frivolous to do that,” he told me. Some other writers, I pushed him, might retreat to the relief of fantasy in his situation. Not Kureishi. “I’m not writing fiction,” he said. “I’m not writing some stupid story, made-up story. I’m writing it directly about what happened to me.” Forget easing into his late phase as a writer. Kureishi has been ambushed by the physical infirmities of age in a rare way. He has always drawn on his own experience, but by choice. A vulnerable, relief-seeking self-exposure is now a necessity, a compulsion—a mode of connection, even as his world has shrunk. It has also offered a way to again rebel against the dominant modes of storytelling. He has one story, and it’s his own, and the only way he wants to tell it is to spit it out raw.

In 1926, after a bout with a devastating flu and a series of earlier nervous breakdowns, Virginia Woolf published an essay on why we don’t—but perhaps ought to—treat illness as a subject as valuable and enlightening as “love, battle, and jealousy.” “On Being Ill” considers illness as a foreign land, a place where “the whole landscape of life lies remote and fair, like the shore seen from a ship far out at sea.” Properly rendering the miasma of sickness and the “daily drama of the body,” argues Woolf—who endured her share of forced confinements in bed—is so difficult that the challenge is rarely undertaken. The ill usually write after they’ve recovered, when the palpable sensations of debilitation are gone, and “our intelligence domineers over our senses.”

Nearly a century later, fiction about illness is still relatively uncommon. Even the best of the genre, such as Helen Garner’s The Spare Room and Elizabeth Strout’s My Name Is Lucy Barton, are told from a caretaker’s perspective or maintain a veil of silence over the specifics of the chemical and mechanical horrors that a body can endure. Excessive depictions of pain, as in Hanya Yanagihara’s A Little Life, can curdle understanding into a kind of grimy sympathy or, worse, distaste. The illness memoir, however, is a well-trodden contemporary genre. First-person tales about cancer, freak accidents, chronic disease, and mental breakdowns regularly make their way onto best-seller lists (or into remainder bins). They typically take one of two approaches: Either the writer finds redemptive lessons in the path toward death or disability, as Paul Kalanithi did in his posthumous megahit, When Breath Becomes Air, or, as in Meghan O’Rourke’s The Invisible Kingdom: Reimagining Chronic Illness, a previously unexamined world of disease is made manifest while the writer explores what we know, and don’t know, about its properties. The hope in both types of books is to impose sense—for the writer and the reader—on the mysterious.

[From the September 2019 issue: Meghan O’Rourke on life with Lyme disease]

The illness narrative usually benefits from months or years of deliberation: It’s a reckoning with how injury or sickness edges into a life and then cracks it wide open. As Kureishi tilted his chair forward and backward, he blithely told me that he hadn’t had a chance to read Woolf or any other books in the illness canon (he can’t hold a novel and doesn’t want to be read to), and that in Shattered, “there isn’t much reflection.” His writing method during the post-accident year he chronicles hardly changed, even when, halfway through, he knew that a book would emerge. Once he was home and stabilized, the suspense petered out, but his from-the-trenches method continued. For a few hours each day, he sat with his son, recording a routine newly cluttered by physiotherapy bills and National Health Service red tape. What winnowing they did was minimal. Shattered is akin to a war diary, prizing immediacy above all else.

Kureishi never planned to produce a stylized memoir. He simply documented the uncertainty and emotional convulsions of the moment. At night, when visitors left his hospital room, he was alone, awake, and imprisoned in his body. “I would write the whole scheme of the piece in my head,” he told me. “One sentence, one paragraph, one paragraph, one paragraph, and kind of hold it there. I could see it visually like a picture.” He’d keep it in his mind until morning, and then dictate in a rush. In an early entry, he notes that he hopes to one day “be able to go back to using my own precious and beloved instruments,” meaning pen and paper, then swerves. “Excuse me, I’m being injected in my belly with something called Heparina, a blood thinner,” he says, then gets right back to praising longhand.

The book’s tone leaps and crashes with Kureishi’s post-accident moods. A model of bountiful gratitude, he praises the Italian doctors and nurses who feed him and move him, who “wash your genitals and your arse, often while singing jolly Italian songs.” When someone comes to measure him for a wheelchair, he writes, “I’ve had enough of this shit.” He turns on himself frequently, worrying that he is “both a helpless baby and terrible tyrant.” Memoirs are designed for revelation, but Kureishi, a connoisseur of shock, invades his own privacy more than most. Nothing is off-limits, including the butt plug he wears in hydrotherapy: His rectum cannot be trusted to control itself. He can’t resist stories, such as one about a threesome he had years ago in Amsterdam, that remind him and us of his wild old days and magnify the contrast with his current straits. How many (sometimes tedious) details we might really want to hear doesn’t concern him. Shattered practices what Woolf calls “a childish outspokenness in illness”; she goes on to note how “things are said, truths blurted out, which the cautious respectability of health conceals.” Kureishi’s mode is impromptu exposé: He has no distance from himself or his condition, and refuses to add any.

For readers, this lack of filter makes Shattered bluntly intimate, demanding in its sharing. For Kureishi, it reflects the urgent purpose of his confessional writing, which is partly financial. “It costs me a thousand pounds a week just to have physio and to go swimming and all that shit,” he told me. Friends donate to a fund, but he’d like to contribute to it himself, with a book that really sells. The urgency is also partly—probably mostly—existential. If Kureishi can’t be out in the world, he needs his voice to be.

Kureishi’s emotions, as you’d expect, surface readily. He cried a few times while we talked, once when I asked him about the knife attack that maimed his friend Salman Rushdie. The two men suffered nearly fatal injuries within months of each other: Rushdie was stabbed onstage at a literary festival in August 2022 and has lost sight in one eye and the use of one hand. They emailed each other daily during Kureishi’s months in the hospital. Rushdie has written his own memoir, Knife: Meditations After an Attempted Murder, in which he carefully and solemnly recounts the way the attack punctured and then reinflated his sense of self. Knife favors a narrative of growth; it aims for closure. Shattered rejects both, never leaving the insistent and unceremonious present tense.

[Read: Salman Rushdie strikes back]

Just as Kureishi hasn’t read the illness canon, he hasn’t read his own memoir. “People tell me it holds together,” he said. He doesn’t seem to need or want proof of that; he knows it’s fragmented. He’s interested in his daily creations as evidence of what feels like newly unfettered access to his mind—of his power to delve into its recesses and skim its surfaces, mobile as he can be nowhere else. That drive shows no signs of ebbing as he now works on a sequel and a movie, his son at his side. “I’ve never felt such a strong desire to be a writer,” he said. “It’s a relief that to be a writer for me is to be a human being, to be sentient.”

*Lead image sources: Stuart C. Wilson / Getty; Universal History Archive / Getty;
Neville Elder / Corbis / Getty; Print Collector / Getty

This article appears in the March 2025 print edition with the headline “‘I Am Still Mad to Write.’”

The U.S. federal government manages a larger portfolio of risks than any other institution in the history of the world. In just the past few weeks, wildfires raged across Southern California, a commercial flight crashed over the Potomac, a powerful Chinese-developed AI model launched to great fanfare, the nuclear-weapons Doomsday Clock reached its closest point ever to midnight, a new strain of avian flu continued its spread across the globe, and interest rates on long-term government bonds surged—a sign that investors are worried about America’s fiscal future. The responsibility of managing such risks is suffused throughout the federal bureaucracy; agencies are dedicated to preparing for financial crises, natural disasters, cyberattacks, and all manner of other potential calamities.

When one of those far-off risks became a real-life pandemic in the final year of Donald Trump’s first term, this sprawling bureaucracy, staffed mostly by career civil servants with area-specific expertise, helped limit the damage, often despite Trump’s own negligence and attempts to interfere. This time, things may turn out differently. Trump is committed to dismantling the federal bureaucracy as we know it—and, with it, the government’s capacity to handle the next crisis. Like an individual who chooses to forgo health or fire insurance, most Americans won’t feel the negative impact of this effort as long as everything in the world runs smoothly. What happens when the next crisis strikes is another story altogether.  

No country was fully prepared for what became one of the deadliest pandemics in history, but it is hard to think of a leader who handled COVID more poorly than Trump. He spent the crucial weeks leading up to the outbreak downplaying the severity of the virus, at one point referring to it as the Democrats’ “new hoax.” His administration never developed a national plan for getting the virus under control and reopening the economy, leaving the states to fend for themselves. Meanwhile, the president undermined his own public-health agencies at every turn, telling states to “LIBERATE” their economies, refusing to wear a mask, and, at one point, suggesting bleach injections as a potential therapeutic. A February 2021 analysis by The Lancet, a British medical journal, found that the U.S. could have avoided 40 percent of the deaths that occurred under Trump’s watch if its death rate had matched the average among America’s peer countries.

[Theodore Roosevelt: An object lesson in civil-service reform]

The administration’s pandemic response did include one shining success: Operation Warp Speed, a public-private partnership that produced and distributed high-quality vaccines in record time, saving countless lives. But that triumph is the exception that proves the rule. The idea for the program came from Robert Kadlec, an assistant secretary for preparedness and response at the Department of Health and Human Services, and Peter Marks, an FDA official—two seasoned public-health experts who had served in top government roles for years beforeTrump took office. The project was then championed by HHS Secretary Alex Azar, who had been appointed by Trump after working off and on for the department since 2001; managed by Gustave Perna, a four-star general who had served in the military for more than 40 years; and staffed by bureaucrats with decades of public-health experience. (This success story has, of course, become distasteful to mention on the right, because it involves vaccines.)

These are exactly the sorts of experienced public servants whom Trump is trying to push out of government. On his first day in office, Trump issued an executive order known as Schedule F; if upheld in court, it will give him expansive new power to unilaterally fire federal employees. In the meantime, his administration is finding creative ways to begin its purge of the federal government. Last week, the administration “reassigned” at least 20 career lawyers at the Department of Justice, allowing them to be sidelined without being officially fired; sent home 160 members of the National Security Council; and offered the remaining 2 million federal employees an ultimatum: Resign voluntarily and receive a severance package, or stay and risk being fired at some point in the future. As Axios reports, the White House expects 5 to 10 percent of the federal work force to take the buyout. Those bureaucrats who remain will, by and large, be reporting to Trump loyalists.

If Trump’s plan succeeds, the inevitable result will be a government that finds itself hamstrung in the face of the kinds of risks that it is designed to manage. (Almost unbelievably, Trump has also floated the idea of abolishing FEMA.) Imagine how much worse the pandemic would have been if Kadlec and Marks, the architects of Operation Warp Speed, had been pushed out of government before March 2020. Imagine if Robert F. Kennedy Jr., an anti-vaccine conspiracy theorist, had been in charge of the nation’s public-health apparatus, and surrounded not by scientific experts but by hard-core Trumpists. How many more Americans would have died?

For now, that question is a thought experiment. Soon, it might not be. In recent weeks, public-health officials have begun warning about the rapid spread of a new variant of the H5N1 virus, also known as bird flu, which infected 67 Americans last year and appears to be becoming more transmissible. Rather, officials were warning about it; last week, the Trump administration instructed federal health officials to temporarily halt all public communications, including reports about the escalating H5N1 crisis, “as the new Administration considers its plan for managing federal policy and public communications.” Kennedy has already cast doubt on the safety of H5N1 vaccines and implied that the virus itself was partly a creation of the U.S. government.

[Kristen V. Brown: Trump has created health-care chaos]

Pandemics are only one example of a broad swath of risks facing America today. Tensions between the U.S. and China are high, the AI arms race is well under way, wars have broken out across the globe, and climate-change-fueled natural disasters have become ever more common. None of this means that a major crisis will inevitably strike next week, or even over the next four years. But Trump’s actions make that possibility far more likely, including by exposing the country to risks that might have previously seemed arcane. On Thursday, the U.S. experienced its first fatal crash of an American airliner in 16 years. This was barely a week after the Trump administration dissolved the federal Aviation Security Advisory Committee, a body that advises the Transportation Security Administration on airline safety, and fired the head of the TSA, whom Trump himself had appointed during his first term. As the aviator and Atlantic contributor James Fallows points out, dismantling the board was likely not directly responsible for the crash, but it represents “the thoughtless destruction of the taken-for-granted institutions that have made modern aviation as safe as it is.” Trump, meanwhile, in a moment that revealed how he might respond to future crises, immediately began blaming the incident on a push for DEI initiatives within the Federal Aviation Administration.

In a crowded field, this might be the most alarming aspect of Trump’s second term. At first, most people won’t notice an agency gutted here or a program slashed there. But those cuts will make disaster more likely, and when that disaster strikes—whether during Trump’s presidency or his successor’s—the government will be far less capable of handling it. What we don’t know is how bad that crisis will be, and whether Trump will still be in office to face the consequences.

When I was unexpectedly diagnosed with ADHD last year, it turned my entire identity upside down. At 37, I’d tamed my restlessness and fiery temper, my obsessive reorganization of my mental to-do list, and my tendency to write and rewrite the same sentence for hours. Being this way was exhausting, but that was just who I was, or so I thought. My diagnosis reframed these quirks as symptoms of illness—importantly, ones that could be managed. Treatment corralled my racing thoughts in a way that I’d never before experienced.

But knowing that I have ADHD, short for “attention-deficit hyperactivity disorder,” has also opened my eyes to a new issue: Apparently, I am at risk of an early death. According to a study published last week that analyzed the deaths of more than 30,000 British adults, ADHD is linked with a lifespan that’s nearly seven years shorter for men, and about nine years shorter for women. Nine years! The findings suggest that the life expectancy of people with ADHD is nearly on par with that of smokers, and about five years shorter than that of heavy drinkers. When I sent the study to my husband, who also has ADHD, he texted back: “Damn.”

The findings are foreboding for many Americans. As of 2022, about 7 million American children ages 3 to 17  had at one point received an ADHD diagnosis as of 2022—1 million more than that same age group in 2016. And although ADHD may bring to mind kids bouncing off the walls, the number of adults with the condition has surged in recent years. ADHD’s rising prevalence has been met with some dismissiveness. As I wrote in 2023, questions have been raised about the validity of the recent spate of adult diagnoses, some of which were offered through dubious telehealth services that haphazardly doled out prescriptions. And ADHD is widely seen as mild, even mundane: Struggling to focus is hardly the same as say, schizophrenia, which has been linked to declines in life expectancy. But ADHD is “not as innocent as some people think it is,” Margaret Sibley, a psychiatry professor at the University of Washington School of Medicine who is not associated with the new study, told me.

No one dies from ADHD itself. Rather, symptoms such as concentration issues, emotional instability, memory issues, and impulsivity can touch nearly every aspect of life. Researchers have long known that people with ADHD are more likely to engage in risky behaviors, including substance abuse, unsafe sex, gambling, criminal acts, and dangerous driving. They are at a higher risk of depression, anxiety, and suicide. Difficulties keeping up with healthy lifestyle habits, such as eating well and exercising, lead to higher rates of obesity. All of these risks can chip away at a person’s life: Around the world, having ADHD is associated with lower socioeconomic status.

Some of the most life-threatening impacts of ADHD may be the least conspicuous, experts told me. Missing doctor appointments, forgetting to take medications, and struggling to navigate the health-care system can make existing illnesses worse. What leads children to be scolded for poor behavior can snowball into difficulties keeping a job, maintaining healthy relationships, and even staying out of prison. Forgetting to pay rent can lead to eviction; the sudden urge to race down a freeway could end in a crash.

The new study points to these sorts of risks to explain how ADHD can cut someone’s life short. Besides the shocking findings, what makes the research so notable is that it is the first to directly quantify years lost to ADHD. By matching diagnoses with death records, the authors calculated the mortality rate of people with ADHD, which they used to estimate life expectancy. A previous study quantified the effect of a childhood diagnosis on lifespan by extrapolating the effect of known risks and came to similar findings. The new research shows that “we have data related to the mortality of individuals—true data,” Sibley said.

The calculations aren’t definitive. The top-line life-expectancy numbers are part of a range that incorporates a margin of error: 4.5 to 9.11 years lost for males, and 6.55 to 10.91 years lost for females. “The estimate is not super precise,” Joshua Stott, an author of the paper and a clinical-psychology professor at University College London, told me. Nevertheless, even the most optimistic scenario discussed in the paper—a reduction of 4.5 years for men—is “still a big difference” in lifespan, Stott said.

Another caveat, he added, is that the study population may have been skewed toward people with additional health issues, possibly inflating the mortality risk. ADHD underdiagnosis is common in the United Kingdom, so it’s possible that those who had a diagnosis had sought it and were overall more in touch with health services. Perhaps the biggest limitation of the study, however, is that it doesn’t show whether treatment helps. Good data on who in the study was treated just weren’t available, Stott said.

Among the researchers I spoke with, there was no question that treatment would help. In fact, the diagnosis alone is even more important—an idea that transformed my fears into hope. Once people are aware of their condition, they can learn about the risks and adjust their lifestyle accordingly, David Goodman, an ADHD expert and a psychiatry professor at the Johns Hopkins University School of Medicine, told me. If ADHD can be diagnosed and managed, “a lot of this would disappear,” Stott said. Certainly, research suggests that drugs like Adderall can reduce ADHD’s effect on life expectancy. That should provide solace for many Americans: In 2023, two-thirds of American adults with ADHD were on medication or in behavioral therapy, or both.

The earlier a person knows about their disorder and the risks associated with it, the better. In a way, ADHD is like diabetes, Goodman said. When it’s treated early, living a relatively healthy life is doable. The longer it isn’t treated, the more the comorbidities pile up: heart disease, vision problems, nerve damage, kidney disease, and so on. With ADHD and diabetes, treatment can involve both drugs and lifestyle changes.

At first, my diagnosis brought relief. Then anger and remorse—that I had spent nearly four decades feeling drained and frustrated with myself when I could have managed my disorder all along. When I shared this with Goodman, he replied: “You and everyone else who gets diagnosed in their adult years.” Underdiagnoses aren’t limited to the U.K.; globally, they are common, particularly among girls and women. Underdiagnosis partly accounts for the growing number of adult cases. Given Stott’s findings, the uptick in adult diagnoses is a positive thing: It means those people have a chance to claim the years they might otherwise have lost. With diagnosis, “the goal is to diminish the regret that you have in the future, given the information and decisions you make in the present,” Goodman said.

But that requires a new perspective on ADHD. Although it has long been classified as a mental-health disorder, it is often seen as a stage that can be outgrown; eventually, the hyperactive child learns to sit still. The notion that ADHD is a serious lifelong disorder remains underappreciated; it’s relatively new, even in the research community. The condition has a dubious reputation among the general public: Just yesterday, Senator Tommy Tuberville lamented the bygone days when, to manage their child’s ADHD, “parents didn’t use a drug, they used a belt.” It is sometimes seen as a path to the recreational use of stimulants. Some scientists still contest the validity of adult ADHD itself, Sibley said: One recently framed ADHD as a false epidemic sparked by an overmedicalized society and self-diagnosis. Indeed, during the coronavirus pandemic, TikTok creators self-diagnosing ADHD led their followers to do the same; whether their assessments were right is anyone’s guess.

At times, I still question my own diagnosis, wondering whether my attention span is just victim to a maelstrom of forces: Texts, social-media alerts, email notifications, and the endless onslaught of news can make anyone feel chronically discombobulated. But I know now that ADHD is more than just a problem of attention; the relief I experience with treatment—from impulsivity and recklessness, angry outbursts, and frantic thoughts—is undeniable. For people with ADHD, the hope is that diagnosis can help disentangle a serious condition from the frenzied realities of modern life. Both are exhausting, but one, at least, can be controlled.

The former British army soldier is sentenced after he was the subject of a nationwide manhunt in 2023.