Mario Anzuoni / Reuters

It was the hives that made Caroline Moss think something was wrong. The New York-based creative director had been getting itchy bumps on her arms and chest since late September, and allergy tests came back negative. She made small talk with her doctor at a follow-up appointment: “I was like, ‘This election, huh?’ And then he asked me if the election was stressing me out. The doctor told me my body may be manifesting my anxiety in this way.” Moss had broken out in hives just after the first two U.S. presidential debates, which she watched and discussed extensively with her friends and on Twitter.

Increasingly, the 2016 election is taking a toll on everyone. The turbulence of this time of national transition can cause anxiety that makes day-to-day life more alarming, but people’s existing fears can also be inflamed by what they see happening in the election. This creates a sort of feedback loop between personal and national anxiety. Social media and a 24-hour news cycle has made it difficult to avoid talk of the election, and Donald Trump's candidacy in particular has given people many reasons to be anxious. Name-calling has devolved into physical violence at multiple Trump rallies, with Trump often egging the perpetrators on from the dais. Women who have been victims of sexual assault have relived their trauma on an almost-daily basis in recent weeks, first with the release of the video in which Trump bragged about sexually assaulting women and then as numerous women have come forward to share their experiences of being groped or assaulted by Trump.

Even if Trump loses, which appears likely, his claim in the third debate that he will not accept election results threatens to cause unrest among his followers. A report from the Southern Poverty Law Center found that minority students are “concerned for their safety” by the possibility of a Trump presidency. The mindfulness app 10 Percent Happier has created a series of guided meditations for election stress. And 52 percent of Americans reported that the election is a “very or somewhat significant source of stress” in a recent poll conducted by the American Psychological Association.

The combination of high stakes and uncertain outcomes is a recipe for anxiety, and national change can create a diffuse anxiety throughout a country. It's happened before. In his book American Nervousness 1903, Tom Lutz makes the case that the year 1903 was the height of neurasthenia—a condition marked by a nervousness about modernism that mostly plagued the upper classes. As industrialization and globalization accelerated, people grew fearful of what the future would hold. 1903 was a year on the brink of social change: President McKinley had recently been assassinated; W.E.B. DuBois had just published The Souls of Black Folk; the Wright brothers flew their first plane at Kitty Hawk, and the American government helped Panama secede from Colombia in order to build (and control) a canal that would change the way trade and travel were done between the Atlantic and Pacific.

“By 1903, neurasthenic language and representations of neurasthenia were everywhere,” Lutz writes, citing examples of nervous literary characters like Rebecca of Sunnybrook Farm, and Teddy Roosevelt’s preoccupation with the declining birth rate among white Americans, which he feared would lead to “race suicide.” Uncertainty reigned, especially among women, who did not yet have the right to vote, and anxiety thrives at the intersection of uncertainty and powerlessness.

To some degree Americans find themselves in this situation—uncertain and aware of how little power one vote really has—every four years. “Hope” was the keyword that carried many voters through the 2008 and 2012 elections, and “fear” has replaced it in 2016: The GOP nominee has inspired fear in minorities and women almost since he came onto the national stage, suggesting that Mexico is sending rapists across the border; that Muslims should be banned from entering the country; that women are available for men to do with whatever they want. And this election has been heated from the primary. Even before Trump won the nomination, the Democratic contest often devolved into insults online, with Bernie Bros and Hillary supporters battling about whose candidate was better suited to implement a progressive agenda. Political arguments devolved into personal attacks, a pattern which has only intensified in the general election.

With the seemingly unceasing stream of revelations that Trump has said or done something offensive or frightening, our national anxiety exists now in a state of near-constant vigilance, especially if you’re frequently tune into news or social media. As long as a person is awake, there is no end to the amount of information she can consume about the election, and with the stakes as high as they are, it's understandable why she may feel compelled to keep reading, even if it makes her feel worse.

Amanda, a legislative staffer from New York City (who asked to have her last name withheld because she works in politics), said that reading about Trump’s “grab her by the pussy” comments kicked her election anxiety into a new gear. “It felt like the floodgates opened,” she said. “I've never worried about the outcome of an election [before this one]...what was anxiety-producing was that feeling of having your worst fears confirmed, that this is how men talk about us when we're not around.” Ruby Arbogast, a copy editor from Oregon, agrees that Trump’s candidacy poses a unique threat to women. Her anxiety “arises from hearing about all the assaults he's committed ... As a woman, I know intuitively that he's dangerous.” Elizabeth Pratt, a college student in Minneapolis, has been encouraged by the progress she’s seen for the LGBT community under the Obama administration. But with the rhetoric of the Trump campaign, “Now this election seems to be a choice between keeping our fought-for human rights as LGBT Americans or having that relative safety and protection stripped away from us.”

Julie Rodgers was a chaplain at conservative evangelical Wheaton College until she and the school parted ways over differences in beliefs about gay marriage. “I grew up in conservative Christian communities that taught that we Christians weren't supposed to be political, just biblical,” she says. “In that universe, ‘biblical’ meant Republican.” Rodgers has experienced increased anxiety during this election, in large part due to how the Christian communities she grew up in have embraced Trump and his supporters. “Christian communities that pushed me out for being gay are eager to get behind someone like Trump, and they manage to justify it with their faith. Evangelical leaders like Wayne Grudem and Eric Metaxas [who have endorsed Trump] were highly respected in my communities. They rejected my LGBT friends and I because of their theological beliefs, and now they've managed to bend those beliefs enough to rally around Trump.” Rodgers’s case is one example of how the fear feedback loop works: Her personal fears about being accepted as a lesbian in the church are worsened by the election, and her fears about the election worsen a situation that was already difficult at home. Fear of one outcome breeds fear of another, and fear fuels itself.

George Miller Beard was a turn-of-the-century neurologist who defined neurasthenia as a depletion of “nerve force,” or nervous energy, brought on the trials of living in the modern era. Specifically, Beard named five forces that, together, heralded an advanced civilization and could therefore introduce neurasthenia: “Steam power, the periodical press, the telegraph, the sciences, and the mental activity of women.” Too much engagement with any one of the five, he said, could exhaust a person’s reserves and bring about a collapse. You can see here how broad national trends were taking their toll on individual minds and bodies.

Treatment for neurasthenia varied according to gender. Women were assigned to total bedrest, often for a month or more. They weren’t allowed any books, paper to write on, or visitors, and were often spoon-fed a diet of milk by a nurse so as to return them to their natural state of dependency. Neurasthenic men, on the other hand—Teddy Roosevelt and Henry James come to mind—were sent into the great outdoors to replenish their nerve force. James got a prescription to hike in the Alps; Roosevelt was sent to the Dakotas for rough-riding.

Nowadays, men and women alike are getting other prescriptions. “I have woken up at 2 a.m. or 4 a.m. almost every night for the past three weeks,” an attorney from Oakland told me. “I’ve started taking anti-anxiety meds before I went to sleep every night. I'm 41, I've been through a bunch of presidential elections at this point, and none of them have made me feel like this.”

Malachi lives in the San Francisco Bay Area, and his disability has made it difficult for him to maintain a job. (He asked that we withhold his last name for this reason.) He says his anxiety is “dramatically worse” since the election started. “My consumption of meds is through the roof.”

Madison, a trans woman living in San Francisco, isn’t enthused about Hillary Clinton but is happy to vote for her over Donald Trump. She is currently in the process of transitioning (and asked to withhold her last name for this reason), but says she fears for her safety under a Trump presidency. “The brazenness that he is imparting into people has definitely caused me to slow down my transition and take everything so much more carefully. Basically, I have to hide.”

The pull of election news has started to divide some people’s attention during work, too. “My productivity has been dramatically curtailed by my increasing perusal of Twitter, various news services, and YouTube,” says David Hackett, a San Francisco-based designer. “I try to not let it affect me, but I know that the cumulative, additive effect is that it does affect me.” Some of the people I spoke with have deleted apps like Twitter and Facebook from their phones, trying to bow out of contentious political conversations as much as possible, but many others said they were checking the news and social media almost compulsively. “With all the controversy surrounding both candidates, it's all the more addicting,” says Bill Lesniak, who works at a commercial printshop in the Chicago area. “You just want to know how it's all going to flesh itself out. Really, it's like the Jersey Shore with less alcohol.”

The 24-hour news cycle and constantly-updating social media feeds can make contemporary elections feel omnipresent and lead to a sense of constant vigilance. Add to that a candidate who is a loose cannon who unpredictably shoots out cannonballs of racist and misogynist rhetoric, and you have a formula for explosive levels of anxiety. When people report feeling more anxious because of looking at the news or their Twitter feed, they are describing an emotional system that the 19th century psychologist William James, described thusly: “The bodily changes follow directly the PERCEPTION of the exciting fact, and that our feeling of the same changes as they occur IS the emotion.” (Emphasis original.) In other words, we do not get afraid because we see a bear, James posits. We get afraid because in running away from the bear, we recognize in our bodies a sort of flight response—quickened heartbeat, shortness of breath, intense focus—that indicates fear to us. Emotions, according to James, comprise physical sensations that give way to psychological impressions. Anxiety can manifest itself in a person’s body without the person consciously noticing it, so that even something as small as a picture of Donald Trump might make a person feel fear instinctively, if they already associate Trump with a threat. That is the insidious nature of anxiety, and it can’t simply be willed away.

What does that have to do with the anxious state we find ourselves in two weeks out from the election? Here’s an example: This summer, I finally, for several months, had conquered the habit of nail-biting that had plagued me for the better part of a decade. I was, finally, proud of my nails, no longer trying to hide my hands in professional settings. But that all went to pot after the second presidential debate. My nails are ragged and red once more. Did I choose to bite my nails to cope with anxiety about the election? Or was it the nail-biting that alerted me to my anxiety? I noticed my nails before I noticed I was anxious, so James might be onto something. And it doesn't take an imminent bear attack to spark a reaction in your body. It might just be a presidential candidate who activates your fight-or-flight response so much that it’s not too long before simply seeing his face, or hearing his voice has you short of breath and hunched over.

National upheaval turning into personal anxiety isn't a phenomenon only found in America. In a 1993 essay about Hindu nationalism in India, Harvard professor Ashutosh Varshney argued that the “separatist agitations of the 1980s ... and a deepening institutional and ideological vacuum in Indian politics” resulted in “a mounting anxiety about the future of India.” Uncertainty about a country's future can lead to mass anxiety no matter where it is found. “Indian politics in recent years have been experienced by a large number of Indians as an anxiety, as a fear of the unknown, and on occasion ... even as a loss of inner coherence.” The rules of the game were changing to something people didn't understand, and there wasn't much they could do about it.

“There’s more hate and vitriol [in this election] than I remember and it makes me sad,” Caroline Moss said. “I wake up every morning not knowing what I am going to hear or read; that things could get worse, crazier, more bizarre, is stressful.” After consulting with a doctor about her physical symptoms, she decided not to watch the third presidential debate. This time? No hives.

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