Jonathan was someone she definitely wanted to keep tabs on, more than any of her other fourteen patients currently on release programs. “Reintroduced into mainstream society,” as the hospital board put it. Some of these patients had colorful histories, a few even violent ones, but none of them, let’s be frank here, she told herself, interested her as much as Jonathan did. He was a one-in-a-million patient, a closet (and then not-so-closet) paranoid who could recall most of the trauma that had landed him in the hospital in the first place, and was willing to talk about it. Unlike most paranoids, Jonathan had opened up to her (though it had taken awhile, she would admit that).

In many of these types of cases, the problem could be traced back to childhood, but that took months and sometimes years of therapy. Many paranoids never had the luxury of assuming the world was a friendly, stable place. They could not trust others, patients would often say, even before the disease became prominent. And they couldn’t react to different situations with a relative shift in emotion; that is, most would react to something very simple and hardly threatening in the same way they might react to a uniformed police officer snapping on the handcuffs.

She remembered a patient of hers she had treated a few years ago, Ron King, who ended up in her care after weeks on the run. He had gone to work at a butcher shop run by an Italian owner several months before, and that was where all the trouble started. Ron had always been a pleasant, quiet person, but after several weeks of work, he had a minor argument with his boss over a paycheck that was a little short, and ended up storming out of the place on a Friday afternoon, the busiest time of the week. Upon getting home, he began to obsess over what had happened and became convinced that the little butcher shop was run by the Mafia, and that the Italian owner was really a trained killer. From that point on, things worsened rapidly; the next day, Ron didn’t dare go to work, and began to realize that there were suspicious-looking people lurking outside his apartment. He pushed a bureau against the door and went out the fire escape. On his way to his car, he decided the police were always taking bribes and probably knew about him already. So he drove out of the city.

Over the next few days, he was sure they were following him, kept seeing them in every face at the truck stops and fast-food places. He kept driving. Finally, a week later and across the country, he attacked a young woman who he was sure had been following him and was “one of them.”