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A taxonomy of movie psychos

Psychiatrist Samuel Leistedt sorts the diagnosable cases from the villains of pure fantasy

S tudying psychopaths is not an easy undertaking, not least because we don’t fully understand what psychopathy is. “Is it a disease? Is it a personality disorder?” says Samuel Leistedt, a professor of forensic psychiatry in Brussels. “We don’t know.”

What we do have to go on are various traits associated with the condition: narcissism, callousness, destructiveness, deviousness, impulsiveness, and the inability to feel love, empathy, or remorse. Psychopaths have been described as “intraspecies predators,” who use all means at their disposal—violence, intimidation, charm—to get what they want. And while they are not always violent, they are reliably horrible.

What makes life truly difficult for people like Leistedt is that psychopaths tend to be exquisite liars. This is especially true of “primary psychopaths,” whose condition is thought to be genetic (as opposed to “secondary,” or environmentally determined, psychopaths). These are the people who, having made the evening news, are described by neighbors as “nice.” They are never out of character.


For the psychiatrist, then, the issue boils down to this: How do you get past the psychopath’s strobing hall of mirrors? How do you study a person you cannot see?

A few years ago, Leistedt decided that one answer to this question might lie in the imagination. Specifically, he proposed that a set of subjects useful to doctors are the psychopaths of cinema. “The idea is that movies can be used as a kind of database,” he says. “Some of them are very interesting in terms of the realism.”

Last month, Leistedt published a research paper titled “Psychopathy and the Cinema: Fact or Fiction?” In it, he and coauthor Paul Linkowski present a list of 126 fictional psychopaths—gleaned from 400 movies made between 1915 and 2010—selected based on what they call the “clinical accuracy of their profiles.”

The study reads like a who’s who of cinematic sickos—Tony Montana, Tom Ripley, Anton Chigurh—all of whom possess at least some of the traits associated with psychopathy. Films in which the villain is deemed to be frivolous or fantastical are ignored (Hannibal Lecter doesn’t make the list).


In the paper, Leistedt also presents a litany of familiar but unrealistic movie types that don’t qualify—“mad scientists, super villains,” who often possess “bizarre mannerisms, such as giggling, laughing, or facial tics.” Leistedt found that on-screen psychopaths have come a long way over the years, and their increasing sophistication has directly paralleled progress in the psychiatric field. Even Norman Bates—Alfred Hitchcock’s brilliantly terrifying creation—looks a bit comic-book by today’s standards.

In fact, Leistedt says, you can trace a kind of evolutionary line through Hollywood psychopaths, from the bug-eyed mobsters of the 1930s (Tony Camone in the original “Scarface”) to the slasher-flick madmen of the ’70s and ’80s (Jason in “Friday the 13th”) to the suave serial killers of the ’90s and 2000s (Patrick Bateman in “American Psycho”) to the more nuanced psychopaths we see today, characters like George Harvey, the sad sexual predator in “The Lovely Bones.” For decades, Leistedt says, filmmakers have mined the psychiatric field for inspiration, and it might be time for psychiatrists to turn their attentions to the movies.

Leistedt spoke to Ideas from his office in Brussels.

IDEAS: You started out looking at 400 movies to put this list together. Did you watch all of them?

LEISTEDT: I did. I watched all of them at least three times. It took me almost three years. Some of the movies I know the dialogue by heart.

IDEAS: Wasn’t it depressing to watch all that horror over and over?

LEISTEDT: It had no effect on me. I was trying to be as objective as I could, trying to make diagnoses and use my skills as a psychiatrist. And I love movies.


IDEAS: Did you have a favorite film?

LEISTEDT: I really liked “No Country for Old Men.” The character in the film is a hit man. I’ve met people like that, who work for criminal organizations, and they were very coldblooded, very cold. You look at this character, and he has no emotion in his face, it’s just frozen. That was pretty scary.

IDEAS: Did you find that there are certain filmmakers who are better at capturing the condition than others?

LEISTEDT: Martin Scorsese has done some very interesting characters. I like Jack Nicholson in “The Departed,” and Nicky Santoro in “Casino.” Stephen King is good. I actually met him in Bangor, Maine, and he explained to me that before writing a book he asks a psychiatrist to help him create more realistic characters, and this is true of Annie Wilkes in “Misery.”

IDEAS: Hannibal Lecter didn’t make your list of cinematic psychopaths. Why not?

LEISTEDT: He’s too smart. He’s successful in everything he does. He eats his victims and he breaks out of jail. He gets inside people’s heads. He’s not physically large, but he’s very powerful. That’s not reality.

IDEAS: What are the most common mistakes filmmakers make with their psychopaths?

LEISTEDT: They make them inhuman and super evil. Like Hannibal, they’re too successful. Closer to the truth is the guy in “Henry: Portrait of a Serial Killer,” who’s miserable, pathetic.


IDEAS: Yet Hannibal Lecter is a far more popular character. I guess most people go to the movies to be entertained rather than enlightened.

LEISTEDT: And Hannibal is entertaining, he’s a very interesting, brilliant man—people like him, especially women—but he’s not realistic.

IDEAS: There are all sorts of frightening people on this list—from Frank Booth in “Blue Velvet” to Patrick Bateman in “American Psycho.” But then we have people like Mr. Potter in “It’s a Wonderful Life” and Gordon Gekko in “Wall Street.” Even in the movies, not all psychopaths are crazed killers.

LEISTEDT: We all have psychopathic traits. It’s a spectrum. Potter and Gekko are greedy and manipulative. There’s a need for success and power. These people can even be socially attractive. They have money. They are smart. They are sensation seeking. They are sometimes very charming. But they can do a lot of bad things to people.

IDEAS: Some people have argued that, with the right balance of traits, there can be such as thing as useful psychopathy. Narcissism and impulsiveness become bravery; lack of empathy helps people make tough decisions.

LEISTEDT: I would say that’s partially true. In terms of war or politics, someone could make decisions and sleep like a baby. The problem is, psychopaths don’t care about other people. Everything they do, they do for themselves, so the usefulness falls down.

IDEAS: Men outnumber women on your list by five-to-one. Is this a matter of bias among filmmakers or does it reflect the reality?


LEISTEDT: Psychopathy in women is an interesting question. Some people say it doesn’t exist. I disagree. Women are less violent than men, but they can poison your coffee and take your money when you die. There are a lot of cases involving what we call “the black widow.”

IDEAS: You mentioned Annie Wilkes. She’s violent enough.

LEISTEDT: I don’t think she is a psychopath—I listed her as a pseudopsychopath. She’s unstable and very dangerous, but to me it seems more like psychosis or borderline personality disorder.

IDEAS: I was trying to think of recent psychopaths who might make your list, and I kept going back to Dexter, the serial killer whose victims are other serial killers. Then he has a kid and discovers empathy, starts caring about people. Is that possible? Can a psychopath be cured, or at least taught not to behave so badly?

LEISTEDT: That’s an important question. When you are a primary psychopath, you stay that way until the end of your life. As we get older, we all become less violent, and there are a lot of papers describing all sorts of options, but a pure psychopath cannot be cured.

IDEAS: Another depressingly realistic depiction of psychopathy recently was “We Need to Talk About Kevin.”

LEISTEDT: That one was very interesting, but it came out after we’d completed the study. I should do a follow-up.

Chris Wright is a writer and editor living in London.