A riot occurs in a mental asylum in Massachusetts led by a doctor, incarcerated after being framed as a serial killer of women. Police call in a psychiatrist to talk the doctor into surrendering, unaware the psychiatrist is the one who framed him.

Enlisted by the FBI for his former successes, forensic psychiatrist Frank Clevenger is assigned the case of the elusive Highway Killer, who is profiled as a brilliant psychiatrist and who engages in a confrontational letter campaign with Clevenger through a national newspaper.

West Crosse, an architect whose clients are America's wealthiest families, not only designs houses but also makes their lives more perfect by murdering an abusive spouse, a toxic lover, a predatory business partner, or an unwanted child. Forensic psychiatrist Dr. Frank Clevenger has been hired by the FBI to investigate Crosse, an assignment that leads to the ultimate cat-and-mouse game.