Not much surprises Dr. Raymond Patterson anymore.
Dr. Patterson, a nationally known forensic psychiatrist, has spent the last 11 years treating mentally ill criminals in Washington, D.C.
His patients have committed crimes that stretch the human imagination.
One had been arrested at the Library of Congress after angrily demanding a copyright for music he said he heard playing in outer space.
"He wanted the millions of dollars in royalties," Dr. Patterson explained. "He was very sick."
Another had rushed the White House with a machete, convinced that the KGB had replaced President Reagan with an impostor. A third patient, John Hinckley Jr., had shot the president.
Now, Dr. Patterson has a whole new clientele -- the most dangerous mentally ill people in Maryland.
He took over in October as superintendent of the Clifton T. Perkins Hospital Center in Jessup in Howard County. Perkins is the state's maximum-security hospital for offenders found not criminally responsible by reason of insanity.
"If you've heard of really sensational crimes going back 20 years in Maryland, they're probably at Perkins," said Daryl C. Plevy, state director of legal, labor and special issues.
Dr. Patterson previously served as acting mental health commissioner for Washington. He is one of no more than a handful of black psychiatrists running maximum-security hospitals in the country.
Reforming Perkins and taking care of its 200-plus patients will be one of the great challenges of Dr. Patterson's career.
The hospital has gone through two acting superintendents in the past four years. Recent budget cuts have left the facility in sad shape.
A national agency has threatened to strip Perkins of accreditation. Administrators shut down three wards that have fallen into disrepair. The hospital closed one after a patient was -- burned while sitting on a concrete floor that housed heating pipes.
Most of the facilities at Perkins were built in 1959. The low, red brick building has no air conditioning. Boards cover some of the windows; a 20-foot-high wall surrounds the recreation yard.
Until recently, a skeleton crew with low morale staffed the hospital. Patients milled about aimlessly with few programs to occupy their time, said Ms. Plevy, after a visit last year. On one ward, she said, a single security guard supervised 20 patients.
"I was scared," she said. "It was pretty intimidating to walk down those wards and know that there had been eruptions of violence . . . that summer."
"Morale was extremely low," said Dagmar Parrish, the hospital's chief social worker. "Things got so grim that anyone who could, got out."
Dr. Patterson says he plans to turn Perkins into one of the best hospitals of its kind in the United States. Some employees are excited about a new direction; others are not. He's already accepted one resignation and told several who oppose change to consider private practice.
While it's far too early to tell, there are signs of hope. Staffing is up in many departments. This spring, the hospital will break ground on a $20 million maximum-security wing.
With a mix of personal warmth and toughness, Dr. Patterson has begun to win over some employees -- or at least make them think twice about leaving.
"Right now, things are shaping up," said Lawrence Taylor, the day-shift security supervisor. "One time last year I was thinking about making a transfer. Now I'm having second thoughts."
During his tenure in Washington, Dr. Patterson developed a strong following. When he resigned in October, associates and patients packed a hospital recreation hall to give testimonials.
"It was like a eulogy at a funeral," said Claudia Schlosberg, an attorney who worked with Dr. Patterson to help reform the district's mental health system. "His appointment as dTC commissioner was the biggest morale boost anyone had ever gotten."
Over the years, Dr. Patterson also has inspired loyality among patients. One of his biggest fans is Lewis C. Ecker, who has spent the past 25 years in St. Elizabeths, a psychiatric hospital in Washington. He admired Dr. Patterson because he stood up for patients' rights and treated them as people, not criminals.
"You never forget an individual who will take the time, even when you're down and out, not only to talk to you, but to listen to you," Mr. Ecker said. "If I had to choose a role model, Ray Patterson would have it hands down."
Dr. Patterson cut short his career in Washington earlier this fall. He had recently built a house in Fort Washington, Prince George's County. When D.C. City Council members tried to enforce a policy requiring appointees to live in the federal district, Dr. Patterson resigned.
"I intend to raise my family where I choose," he said.
Maryland had been trying to lure Dr. Patterson north for several years. When he finally accepted the job, state officials were elated.
"People all over the country were fighting to get him," said Ms. Plevy.
Raymond Patterson grew up on the South Side of Chicago between two rival gangs, the Black Stone Rangers and the Devil's Disciples.
Several of his childhood friends died violently; some went to prison. One of his friends had two brothers who were gang members.
"They kept us alive," he said.
Raymond was a curious, clever boy.
"He kept asking 'Why?' from age 3," said his older sister, %J Madalyn. "And he wanted to hear story after story after story."
His parents split up early on. His mother, a nurse, raised him and his sister on a salary of less than $5,000 a year. They lived with his maternal grandfather, who introduced him to music and the world through recordings of Enrico Caruso and National Geographic television specials.
After high school, Raymond went to Northwestern University on an academic scholarship. While he was in college, his mother, Vinita, returned to school part time to become a teacher. Her initiative made a big impression.
"When she went back to school, her grade-point average was better than mine and my sister's," Dr. Patterson recalled.
Raymond completed his prerequisites in several years and was accepted early to Howard medical school in Washington without a college diploma. He graduated from Howard at 24 and soon joined St. Elizabeths.
Forensic psychiatry presented him with a great challenge: treating and rehabilitating some of society's most difficult and dangerous members under the scrutiny of the judicial system. It is a discipline that also requires him, case by case, to balance individual civil rights with public protection.
"It's a difficult tightrope to walk at times, but not an impossible one," he said.
Often, he must first sift through fact and fiction to determine whether someone is insane. Some perfectly sane criminals will say anything to avoid death row. Others, who are quite mentally ill, will try to hide it.
To figure out who's telling the truth, Dr. Patterson relies on everyone from colleagues to hospital workers. If a person says he can't sleep because he hears voices, Dr. Patterson will check it out with a night security guard.
Perhaps the most important and nerve-racking part of his job is predicting the future.
"That's what makes forensics so hard," he said. One can look at a schizophrenic or a bipolar person and predict that he will function well in society, Dr. Patterson said. But if he comes home one day to find his wife in bed with his best friend, who knows?
"Whether you have a significant history of mental illness or not, that might rock the boat," he said.
During Dr. Patterson's five years as forensic director in Washington, the recidivism rate for outpatients was 12 percent, well below the 50 percent to 70 percent rate at a number of area prisons, he said.
In person, Dr. Patterson's demeanor is that of a cool-headed diagnostician. He speaks softly and deliberately. He limits his gestures to forming a church roof with his fingers when he expresses a thought.
He is not above analyzing himself. Despite his calm exterior, he admits to being a pretty aggressive person.
He expresses some of his forcefulness through his interest in predatory reptiles, he says. He owns two snapping turtles. One named Mack is 22 years old. He also has an iguana named Diego. His boys, age 9 and 12, have snakes and lizards.
With his various responsibilities, it is hard to spend as much time with his boys as his parents and relatives spent with him. Last month, his work kept him from attending a Thanksgiving celebration at his boys' school.
"It's not without some price," he said.
An old black-and-white photo hangs in Dr. Patterson's new office. It is a portrait of Clifton T. Perkins, for whom the hospital is named. Mr. Perkins came from Massachusetts and reformed Maryland's mental health system earlier in the century.
"I see very much the same mission," Dr. Patterson said.
"I truly believe if you give people resources and direction, more times than not they'll do well."
But "in forensic psychiatry I've seen people do all kinds of things. I'm not naive."