When Donald Trump won in 2016, my young daughter wept.

She had worked hard with campus groups trying to prevent sexual violence. She felt like 56 million Americans had decided sexual assault was not a big thing.

Imagine that four years ago someone had said that we would elect such a man. A man who dodged the draft while bragging that his Vietnam War years were spent bagging women and avoiding venereal disease. A man who belittled the sacrifices of an American hero who did serve in Vietnam and suffered mightily. A man completely unbridled by any semblance of integrity. A man whose only qualification was being a “hugely successful business genius” (Trump’s words), while he was nothing but a “phony, a fraud, a con” (Mitt Romney’s words).

I would not have believed it possible then, but understand it now. Many desperate groups made a deal with the devil to get what they wanted.

Right to Life and right-wing Christian groups got a Supreme Court favorable to their goals. The wealthy got a $1.5 trillion windfall. Those favoring GDP growth over protecting public lands, clean air/water and tackling climate change have done quite well. Those who despise government and everything President Obama accomplished are gleefully at work with a wrecking ball. Bigots, white supremacists and hate-mongers got what they wanted, even without having to make a deal.

While I understand how he was elected, I am baffled by his continued support. I would have hoped some Christians would have been repelled by his un-Christ like behavior and indifference to human suffering.

What about those who cherish democracy. Are they not bothered by his threat to a free press, obstruction of justice and denial of constitutional congressional oversight. Add to this his conflict of financial interests, embracing murderous dictators and indifference to Russian interference in our elections.

Fiscal conservatives should be alienated by his ballooning of the national debt and his threats to the independence of the Federal Reserve. What about active duty and retired military personnel? In January 2017, a Trump-authorized raid in Yemen ended badly. Trump ignored a long tradition of commanders accepting responsibility. He blamed Obama. The bedrock of the military I served in was integrity. His dishonesty, disloyalty, and lack of humility are breathtaking.

Conservatives would say it is the economy that explains his support. I would say the economy is on the trajectory that existed when he took office and continues to overwhelmingly benefit the wealthy. Despite all of this, his roughly 40-some percent support remains rock solid.

I have been unable to explain this — until recently. I found the answer in, of all places, a psychiatry lecture.

That Donald Trump has a personality disorder (narcissism) is no secret. Traits include an inability to tolerate criticism, an inflated sense of self-worth, a strong sense of entitlement, a lack of empathy and a tendency to exaggerate accomplishments. Having a bit of this may be part of seeking the presidency and does not preclude success. That his narcissism is extreme makes his presidency dangerous, but this is not the main point.

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A lesser known part of this disorder is the unique ability of narcissists to acquire cult-like followings. Herein lies Trump’s true genius. He acknowledged as much when he bragged about randomly shooting someone without loosing a voter. His success in acquiring a cult-like following is not remarkable. It is historic and history is rife with the tragic consequences of such “success.”

Knowing this, we should not expect that his support will dwindle, regardless of past or future misdeeds, rational arguments or cold hard facts. Knowing this, his removal becomes imperative. Beating him in 2020 will require an “all hands on deck” effort. He has an impregnable base and is unencumbered by a moral compass. He is a threat to our democracy.

Douglas Douville, M.D.