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Insane Equals Violent

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A fictional character who is insane (in the psychotic, out-of-touch-with-reality way) is usually also violent. Thus, in typical TV-land logic, if you become psychotic, you must also become violent—even if you never were before. A character who already resorts to violence will turn on their friends instead of fighting whatever enemy they usually fight. (Conversely, a villain or antihero who engages in unnecessary violence will often be called "psychotic" as an insult both in- and out-of-universe, even though that character is more often than not completely sane, or at the very least sane enough to function normally.)
What's more, the fictional psychotic will not only be violent, they'll actually be more lethally effective than a sane person. Count on the villainous psychotic to be a nigh-unstoppable assassin who's mastered Offscreen Teleportation rather than, say, a poor deluded individual uselessly arguing with or attacking their own hallucinations, or getting caught after committing a crime they were too confused to know was even a crime at all. Expect plenty of ridiculously heightened abilities, ranging from super-strength to freakish imperviousness to pain.
This is usually used to enhance the frightening aspect of a character since psychosis makes them unpredictable and their behavior unfamiliar. In a fight, they have terrifying Confusion Fu. Many slasher-film villains are insane; most characters perceived as psychotic are also violent and unpredictable. The very connotation of "escaped lunatic" is that of a violent person, an urban-myth trope that goes back as far as the first mental asylums. The same goes for "psycho", "madman", and "insane", all of which commonly imply violence or evil (or both).
Although over one-third of the world's population qualify as mentally ill at some point, media coverage of mental illness is mainly comprised of extremely negative and derogatory depictions — as you can see on TV Tropes itself. Incompetence, violence, or criminality are generally the forms that appear in fiction, with far less depiction of 'uninteresting' conditions such as depression, catatonia, or 'harmless' OCD. In 1999, characters in prime time television portrayed as having a mental illness were depicted as the most dangerous of all demographic groups, with 60 percent shown to be involved in crime or violence. Such negative depictions, including in children's cartoons, are thought to contribute to stigma and negative attitudes in the public and in those with mental health problems themselves, although more sensitive or serious cinematic portrayals have increased in prevalence.
This trope has some roots in Truth in Television, though of course different mental illnesses will differently affect a person's propensity towards violent crime: some illnesses (like antisocial personality disorder) have violent behavior as a symptom, whilst others (such as depression) actually make a person less likely to commit a crime. Overall, people with mental illnesses do commit slightly more violent crime than average. However, it's not anywhere nearly as common as media would imply: mental illness is an extremely weak predictor of violence, to the point of uselessness even when compared to simple demographics like being young or male. Mentally ill people are also more than eleven times more likely to be victims of violence (although it should be noted that the people in that statistic were seeking help, whereas the ones who were not were most likely not). Alcohol and drug abuse are associated much more strongly with violence, and when you account for the increased prevalence of drug and alcohol abuse among those with mental illnesses, the extra risk of violence for mentally ill people overall vanishes completely... but that's not as interesting.
This is becoming more of a Discredited Trope, thankfully, as more writers are leaning towards interesting motives for violence, but still lingers on in the Horror genre.
See also: Ax-Crazy. Compare it with Sanity Has Advantages. Contrast Loon with a Heart of Gold.

Examples
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In Asylum (1972 Horror), Rutherford believes that his patients "can't be cured, they can only be confined — and kept from being dangerous". He gives the example of Dr. Starr, who attacked him and injured his leg, leaving Rutherford wheelchair-bound. Of the patients who Dr. Starr might be among, the only one who apparently averts the trope is Bruno — of the rest, both Bonnie and Barbara have been accused of murder (which they blame on an apparently nonexistent party), and Byron uses a Living Toy to murder Rutherford. When Starr's identity is finally revealed, he proves to be just as violent as Rutherford claimed, having killed and replaced an orderly and murdering Dr. Martin when he discovers the body.
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Interestingly, this is often subverted in Adventure Time. The three most obviously mentally unstable characters, The Ice King, Lemongrab, and the Tart Toter, aren't evil or violent. The former is a wizard who occasionally will battle Finn, but he isn't any more violent than the sane characters on the show. As for Lemongrab and the Tart Toter, these guys are just mentally unstable — not violent. It's the sane characters, aka Finn, Marceline, etc., who display occasional violent tendencies.
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Watchmen plays with this in many ways, by averting both Hollywood Psych and Single-Issue Psychology:
In the book, there are very few supervillains, and the ones who were, like Moloch, quit a long time ago when the first super-powered hero Dr. Manhattan arrived on the scene. The alleged heroes, however, are full of neuroses. The Comedian is The Sociopath, a highly amoral Blood Knight who tries to justify his vision by repeatedly telling idealistic do-gooder heroes that At Least I Admit It. The backstory reveals a more complex, guilty, lonely, and pathetic individual underneath that cynical facade.
Rorschach is a Sociopathic Hero, described by Moore as "Batman without the excuses". He lives alone, prowls the streets and bars, believes in all kinds of conspiracy theories, and sees himself as the Only Sane Man. He was already violent and unstable even before a certain dog incident but after that, he becomes even more violent, in his own words explaining that he had been merely soft before because he let his victims live.
Malcolm Long, a sympathetic and realistic psychologist character, is himself hurt and struck by Rorschach's grim Black-and-White Morality after hearing about his Despair Event Horizon. What makes Rorschach different is that he's not as consistent as he believes as seen in the end when he opposes Adrian Veidt's Utopia Justifies the Means atrocity using the same arguments that Rorschach used in justifying Harry Truman dropping the bombs on Hiroshima and Nagasaki.
Nite Owl is more sane than other costumed heroes, but he does admit to Laurie that the costumes do give grounds to act out harmless Casual Kink as seen when he and Laurie have sex in costumes after they couldn't make out in civilian identities.
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Bag Enders features Frodo. Even Gandalf is scared of him.
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The Unstoppable Wasp: In the second volume, A.I.M. attacking G.I.R.L. sets off Nadia's undiagnosed Bipolar Disorder. When the rest of Nadia's friends confront her upon realizing something was wrong with her, they end up aggravating her problems (which were already bad due to sleep deprivation) and she goes violent on them. When she comes down from that high and realizes what she's done, she's nearly Driven to Suicide, but is saved by one of her other friends.
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Cody Rhodes is often emotionally unstable, has suffered several mental breakdowns, and may have some form of dissociative identity disorder. His brother Goldust may be crazy or just weird.
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Dragon Age:
Played with. The Qunari teach that without the stabilizing influence of the Qun (their religion), their people will invariably go insane and start murdering indiscriminately. People who have left the Qun are called "Tal'Vashoth," and they are almost exclusively some of the worst bandits and murderers anyone has ever heard of. However, it's strongly implied that there's a lot of Self-Fulfilling Prophecy going on; Qunari soldiers are never taught how to do anything but fight, so if they leave the Qun they have no choice but to turn to banditry or mercenary work to survive. And since they've been told that people like them are all insane murderers who will be killed on sight, they have no reason to keep their violent instincts under control. Qunari from other castes are able to live perfectly peaceful lives when they leave the Qun, but the Qunari don't mention them because they don't fit the narrative.
Played depressingly straight in II with the case of Kelder Vanard. By all accounts, he's a gentle soul, but he also hears demons (probably auditory hallucinations and not actual demons) in his head telling him to kill elven children for the crime of being too perfect. Kelder can't stop himself no matter how hard he tries, and Thedas has no treatment for his mental illness. The only real solution is to Mercy Kill Kelder like he begs once you catch up to him.
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Runaways: In the last arc, Klara suffers a panic attack and lashes out at her teammates, resulting in the destruction of the team's house. To be fair, most of the damage to the house comes not from her personally, but from the plants that she summons (over which her control depends on her emotional state), but she herself punches and kicks Nico Minoru several times, causing the latter to resort to Mind Rape to force her to calm down.
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AI: The Somnium Files plays with this trope in regards to its main villain, but ultimately averts it. Saito Sejima was born with a brain disfunction that caused him to receive a rush of dopamine whenever he killed someone, and this was the only instance where his brain would ever release it. To keep chasing the high that killing gave him, he became a Serial Killer. After a series of body swaps, he ends up in a different body while the game's protagonist, Kaname Date, ends up in Saito's body. Date, now having Saito's same brain condition, receives treatment and ends up becoming an outright better person than he was in his original body. Saito continues to seek the high he got from killing people, but finds himself to be miserable as most brains are not wired to make you happy when you kill someone. Instead of trying to find some other outlet to get satisfaction, however, he chooses to keep killing people and get back into his original body so that he can enjoy killing people again. So while Saito's condition was certainly a factor in causing him to become a serial killer, the fact Date is a good person even though he has the exact same condition and the fact that Saito chose to continue being a serial killer even when he no longer had said condition show that he didn't need to become one. Condition aside though, it must be mentioned that Saito isn't exactly "insane" as he is by no means out of touch with reality and there is a clear line of logic to what he does. Furthermore, there is no real-life equivalent of Saito's and Date's condition, in contrast to other characters with neuroses like Mayumi or Iris.
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In Love Actually, Laura Linney's character's brother is in a mental hospital. We only see and hear from him briefly, and it seems he has some kind of paranoid disorder (he thinks the nurses are trying to kill him and wants to hire either the Pope or Jon Bon Jovi to perform an exorcism for him). When she visits him, he hauls off and tries to hit her without warning and for no reason. A hospital worker rushes in to stop him and then he's fine again.
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In Dark Souls, any being too heavily afflicted by the titular Dark Soul will inevitably devolve into a raging, psychopathic beast that attacks anything that looks at them funny (and many things that don't). Dark Souls III explains why in its The Ringed City DLC; Gwyn's fear of the Dark Soul and those that can wield its power led him to craft the Darksign as a brand that would cut off humanity's access to their dark souls and the Abyss. Over time they lost the ability to properly control the dark as they were meant to, leading to its two manifestations seen in the series proper; either as the Undead Curse or as a Super Mode that confers great power but completely destroys the mind and soul of whoever is afflicted by it.
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Duncan Jones is revealed to have an evil clone in the form of "Lalnable Hector". He's described as being mentally insane and apparently has a love of butchering testificates.
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Vampire's Kiss: Peter becomes increasingly violent as he loses his mind in the film, to the point of committing rape and murder. It's justified though as his delusion involves believing he's a vampire. He also hates what he's becoming and even wants to die by the end over it.
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Jason, the hockey-mask-wearing psycho from the Friday the 13th films. Most slasher movie villains in general are either this or some supernatural thing that's returned for revenge.
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After Dark, My Sweet: Escaped mental patient William "Collie" Collins is generally docile and polite when left to his own devices, but he'll lash out violently whenever he thinks he's being insulted.
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Hidan of Naruto, though his "insanity" takes the form of membership in a cult that worships a god of murder and powers that combine violent self-mutilation with immortality and sympathetic magic. Since all the major characters are ninja, violence is a given.
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 Naruto (Manga)
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One crisis of the week in 7 Days (1998) involved previously normal people in a small town having sudden outbursts of horrible violence. Olga, the team's resident medical expert suggests this could be the result of a "psychotic break". A psychotic break means losing touch with reality, and would be a very dubious explanation for why someone with no previous history of violent behavior starts attacking people.
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Mr Rochester's wife Bertha in Jane Eyre often snuck out from her room and tried to kill Mr Rochester a few times. She even bit and stabbed her visiting brother. And it culminated when she tried to set Jane's room on fire (not knowing Jane had run away two months earlier), leading to the whole house burning down and her own Karmic Death.
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30 Days of Night: Subverted in 30 Days of Night: Bloodsucker Tales with Lex Nova, a deranged vampire who believes himself to be a private eye and goes on brutal rampages the second he tastes blood. He's actually a genuinely heroic Friendly Neighborhood Vampire who only feeds on goats and directs his rampages on other, malevolent vampires and a group of misogynistic Serial Killers
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Gregory AKA the Stray Dog in Rule of Rose fell into depression after his son's death. He ended up kidnapping other children as replacements and killing them when they didn't perform adequately, and stalking the countryside on all fours like a mad dog.
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The second game is an aversion. Alice is violent in her fantasies but almost completely helpless in real life. The only time she actually hurts someone in the real world is when she pushes Bumby into the path of an oncoming train at the very end of the game which, chances are, the player would too if they could.
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Harry Potter:
Bellatrix Lestrange, Voldemort, and the Gaunts are all utterly insane, presumably from inbreeding. All of them (Merope excluded) openly attack people for reasons including amusement. In a subversion, Order of the Phoenix shows us Alice Longbottom, who is so insane that she can't recognize her own son, but just stands around, smiling weakly and handing out bubblegum wrappers. There's also Lockhart, who is pretty much treated like an overexcited child.
The subversional ones are actually truer to life; the spoilered example is sedate, but utterly detached from reality, and occasionally wanders a bit. Lockhart doesn't just get treated like an overexcited child, he behaves like one as well; he's aware that he seems to be incredibly famous but has no idea why, and the whole thing is an exciting mystery to him.
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The Voices: Jerry at first just suffers auditory and visual hallucinations. However, once one hallucination starts telling him to kill, he becomes a serial killer. However, he struggles against this aspect of his mind and hates himself after giving in.
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Deconstructed in Housebound. The heroine discovers that her house used to be a halfway home for the mentally ill, but was closed down after one of the residents, a girl named Elizabeth, was murdered. When Elizabeth's ghost appears to be haunting the house, solving her murder becomes the driving question of the story. We're led to believe that the killer was another resident, an Idiot Savant named Eugene who turns out to be still living inside the walls of the house and was ultimately responsible for all the seemingly paranormal happenings, but in the final twist, the real killer is revealed to have been one of the care workers at the house, who couldn't cope with Elizabeth's illness and murdered her out of frustration, and Eugene is actually a Misunderstood Loner with a Heart of Gold.
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Andrea Cavalcanti/Benedetto in Gankutsuou is an effortlessly charming fop who happens to also be a wild-eyed rapist with daddy issues. Best demonstrated when he tries to rape his fiance Eugenie and suddenly attacks Haydee.
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Rocko's Modern Life subverted this when a clearly unhinged mailman with an issue of Psycho Weekly scared all the nearby subway passengers away by making a seemingly threatening comment about becoming disgruntled ever since he was laid off. He then proceeds to take advantage of the cleared-up space by innocently swinging on a subway strap.
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In Everybody Loves Large Chests every character who is written to be mentally unstable tends to kill everyone in sight once they have the opportunity.
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Supernatural:
Played straight with Castiel after he absorbs 50,000 souls from Purgatory in order to become powerful enough to defeat Raphael. He was always a soldier willing to kill to achieve his goals, but in this case, he goes completely off the rails and kills thousands of his fellow angels when they won't accept him as the new God.
Inverted with Castiel after he absorbs Sam's memories from Hell. The former angelic soldier becomes a Cloud Cuckoolander and pacifist, refusing to make himself useful during the fight against the Leviathans.
Played with with Marin, the girl Sam befriends in a mental hospital. Everyone assumes she's violent and crazy, but Sam realizes she's being haunted by the ghost of her brother and he's the violent one.
Happens to certain ghosts when they become angry spirits. Bobby fears becoming this and thus asks the Winchesters to put his soul to rest.
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Homicide: Life on the Street:
The killers in "A Many Splendored Thing" and "Subway" are mentally ill. They're treated fairly sympathetically, and the former even turns himself in out of guilt.
Zig-Zagged with Pamela Wilgis, the White Gloves Killer. She claims to have at least eight different split personalities, but there's hints that she's faking it to get a lighter sentence. However, her final conversation with Pembleton shows that there's definitely something wrong with her, split personalities or no.
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Randy Orton displays sociopathic tendencies and claims to hear voices on occasion.
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Elementary:
Subverted in the first episode. The serial killer is a mentally unstable man with violent inclinations and an obsession with red-headed women. He was well aware of his problems, however, and went through multiple psychologists in an attempt to control himself. His current psychologist was dosing him with steroids instead of tranquilizers in order to make his problems worse, all to push the man to kill the psychologist's wife so that he could get her fortune without a costly divorce.
Subverted again in "Tremors". A man walks into the precinct carrying a shotgun and ranting about how he's "the knight" who killed "the queen". Sherlock immediately works out that the man is schizophrenic with a delusion rooted in Middle Ages chivalry and is able to talk him into surrendering the shotgun. The subsequent investigation reveals that "The Queen" is his girlfriend who was actually murdered by her doctor to cover up his questionable treatment of her heart condition. The doctor took advantage of this trope to frame the boyfriend by manipulating him into thinking he shot her.
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Subverted in an episode of The Closer — the father of a disorganized schizophrenic confessed to a murder even he thought his son had committed, when in fact the son had merely discovered the body.
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Fun and Fancy Free: Donald Duck, in "Mickey and the Beanstalk," shown in the trope picture, having a hunger-induced breakdown and attempting to kill their cow so he, Mickey, and Goofy can eat.
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Bellatrix Lestrange, Voldemort, and the Gaunts are all utterly insane, presumably from inbreeding. All of them (Merope excluded) openly attack people for reasons including amusement. In a subversion, Order of the Phoenix shows us Alice Longbottom, who is so insane that she can't recognize her own son, but just stands around, smiling weakly and handing out bubblegum wrappers. There's also Lockhart, who is pretty much treated like an overexcited child.
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 Harry Potter and the Order of the Phoenix
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Bird Box: Justified by the creatures' influence. Anyone with a history of mental illness, regardless of how harmless they were before, becomes obsessed with making everyone else look at the creatures.
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Farfarello of Knight Hunters falls under this, particularly in the backstory. As a child, he snapped and killed his whole family, despite apparently being a perfectly normal kid beforehand.
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Swan Song: Does. It. Ever. Alvin Magrim and his fellow escaped mental patients would be right at home in an unrated slasher flick, although some of them merely seem to follow Alvin's lead and shuffle around in confusion after their leaders are killed or injured.
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Rituals: Matthew Crowley is a disfigured World War II veteran driven insane by brain damage he sustained during the war, which has made him violent and dangerous to be around.
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The Twilight Zone (1985): In "Need to Know", Mrs. Hotchkiss has gone insane after learning the meaning of life from her husband. When the government agent Edward Sayers is questioning her, she tries to attack him with the knife that she had been calmly using to cut a cake a moment earlier. Edward is stunned but manages to fight her off.
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Scooby-Doo: Camp Scare: In one of the campfire stories, Jerry McCreedy, aka the Woodsman, is said to have been driven insane from head trauma, and he roams the woods with an axe. Of course, McCreedy was already mean before going mad, which would give him an additional reason to become violent after losing his mind.
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In The Order of the Stick, this was the result when Xykon threw a bouncy ball inscribed with a Symbol of Insanity into the throne room of the Sapphire Guard. Only a few named members were unaffected, and the last survivor from the ensuing bloodbath committed seppuku out of grief. Justified since that's how that particular spell works in D&D.
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Higurashi: When They Cry is full of this. In the plot's defense, it does try to justify it via Hate Plague, and one of these people — Keiichi — actually does have some violent background before coming into contact with said Hate Plague; he shot at people with a BB gun and accidentally injured a little girl's eye.. Of course, the main symptom of Hinamizawa syndrome is extreme paranoia, and when you think somebody is about to kill you, what do you do?
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The Silence of the Lambs: Hannibal Lecter. Jame Gumb. Frances Dolarhyde. Jacob Garrett Hobbes. Then again, when part of the premise of a series is that it's about catching serial killers...
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Discussed in the Hurog duology. Ward notes that his Obfuscating Stupidity, which involved talking in a loud voice and slapping people on the back with a bit too much strength, frightened his brother. In an aversion, Ward's mother, a drug addict and Cloud Cuckoolander, is completely harmless.
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Count Waltz of Eternal Sonata tries to cause this by making the madness-inducing cure-all mineral powder relatively affordable. Because the madness only sets in after a period of time with the normal powder, most people don't make the connection. And in the meantime, you start being able to use magic. Waltz's motivation for doing this is to turn the population into insane magic-users because those make good soldiers.
Though there are others who you never fight, such as the guy who just walks in a straight line, forever.
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Apprentice and Pregnant: Ivypaw trying to murder her best friend's brother for yandere reasons is excused because she has an unmedicated mental illness that she inherited from her mother. She's punished, but it's not as severe a punishment compared to what she would have been given if she had been in her right mind.
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Misfits: Zig-Zagging Trope. Lucy, a psychiatric patient Simon knew from his time in an institution, tries to murder them after mockery from the others and Simon ignoring her. However, he isn't shown as violent in spite of his own mental health issues (or no more than anyone else), nor do the other mental patients we see act this way. It may also be a case of her power allowing Lucy to strike out with more impunity than otherwise that leads to this.
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Many of the more violent wrestlers in the WWE, Face or Heel clearly have some kind of mental problem.
Randy Orton displays sociopathic tendencies and claims to hear voices on occasion.
Cody Rhodes is often emotionally unstable, has suffered several mental breakdowns, and may have some form of dissociative identity disorder. His brother Goldust may be crazy or just weird.
Mick Foley has multiple personalities, all of which display their own individual mental illnesses or abnormalities.
Dean Ambrose acts like a crazed animal.
Boogeyman was completely delusional and Lost in Character.
Al Snow talked to a mannequin head.
The Undertaker during the Ministry of Darkness angle which is widely considered to be his most evil & violent period. Mark, aka Mark Calaway, (Kayfabe) became lost in The Undertaker gimmick and genuinely believed he was The Lord of Darkness. Vince then points out that not only is he believing, but he has others believing as well.
Bray Wyatt initially was just a possibly-demonically-possessed, ax-crazy, backwoods cult leader who spoke in dark, cryptic riddles and preached sermons about death and destruction on a nearly weekly basis. As the Fiend, he is a Monster Clown who is even more sadistic.
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Warframe: The original warframes were driven insane by the conversion process, leaving them as little more than violent, mindless animals completely unsuited to acting as soldiers. Of course, it didn't help that the Orokin tried to solve this problem by torturing them more and then wondering why that didn't work. Eventually the Orokin had the Zariman Ten-Zero survivors, a group of children with strange Void powers, try. The Orokin assumed that the children would use their powers to break the warframes, but instead they simply showed them basic empathy and compassion, which calmed them down. Together, the children and the warframes became the Tenno.
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The Practice: Mentally ill people are invariably violent, mostly killers on the show. It's justified as otherwise they wouldn't be facing criminal charges that the firm defends them from.
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Bird plays with this concept. While many patients are dangerous, the danger has no direct correlation to insanity. Sveta is very violent, but perfectly sane, as it is entirely her power's doing. Burnscar is somewhat less violent but also has mental and emotional problems to match. Taylor is initially very hesitant to use her powers in an effort to avert this in herself.
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Taken to the extreme in Soul Eater. Insanity, fear, madness, etc. is basically this universe's Virus. You can be infected with insanity, and being insane means that you have the urge to hurt things. By killing humans and eating their souls (which is what insane people do, apparently), one can actually become an Eldritch Abomination. This is how the series' Big Bad Asura became the Big Bad — he was a nervous person who succumbed to his fear, took the life of an innocent human, and consumed their soul in order to gain power. (Ironically enough, consuming the soul of a corrupted, insane person in this series has no negative side effects whatsoever.)
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Defiance: Pilar has an unspecified mental illness. With medication, things were fine. Once its production was disrupted by the door however she had a psychotic break, trying to kill her children, for which Rafe banished her.
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James Marcus of Resident Evil 0 is driven insane by his death (and subsequent rebirth via virally-infected leeches) which turns him from a relatively mild-mannered scientist into a revenge-fueled monster who slaughters an entire train full of workers — and then a training facility — and he's implied to have released the T-Virus in the first game, which leads to an entire city being NUKED.
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An interesting variation happens with the character of Salad Fingers. Salad Fingers seems to be oblivious of the death of those around him, and those he directly causes seem to be him forgetting or neglecting them. While he is a Nightmare Fuel Station Attendant, it's not stated how much of it is actually intentional. However, he very violently engages in Self-Harm and enjoys it.
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Averted with Edna & Harvey: The Breakout: the patients at the asylum are perfectly harmless except for Edna and the Keymaster.
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In Miracle on 34th Street, Doris worries that because Kris Kringle believes he's Santa Claus, he'll eventually become violent. Subverted, in that not only is he harmless, well...
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The X-Files:
"Grotesque" has a Serial Killer who claims that he's possessed by some dark spirit. Scully thinks he suffers from a dissociative disorder and Mulder informs us that he spent the better part of his twenties in a mental institution. The episode deals with the issue of spirit possession versus insanity.
In "Chimera", the monster-of-the-week is revealed to have got some kind of dissociative multiple personality disorder: split personality. The woman's overt self was not aware that it was she who was committing the murders.
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Dungeons and Dragons 3.5 features several spells that can cause the target to become insane. An insane person has to roll on a chart to see what their character does; there is a 10% chance the character acts normally, a 20% chance to run away as quickly as possible, etc. The highest probability action (30% chance) is that the character attacks the nearest creature, friend or foe.
Also the spell Call Forth the Beast in the Heroes of Horror book. The next time the target goes to sleep, they immediately wake up with a bloodthirsty, psychotic attitude with the sole goal of as much violence and bloodshed as possible. After the spell wears off they fall back asleep and wake up with no memory of what happened.
In 4E, there is a whole host of powers that force your enemies to attack each other; most have "madness" or some synonym thereof right in the title.
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Al Snow talked to a mannequin head.
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Averted in Dwarf Fortress: Crazy Dwarves might go berserk and attack other dwarves and kill people, but they're just as likely to be Driven to Suicide or strip off their clothes and run around naked. The players, however...
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In the Xandri Corelel series, this trope is part of the reason why prenatal genetic modification became common. People blamed autism and mental illness for the increasing number of shootings, so by the time the dust settled, gun control had been implemented and most mental conditions had been eliminated.
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Horace and Pete: A surprisingly realistic version. Pete has some sort of disorder that causes psychosis, and this occasionally makes him act out violently, but this is always due to Pete being terrified by his hallucinations and panicking. Everyone (except Uncle Pete, and Sylvie to an extent) avoids holding it against him and make efforts to calm him down when he is like this. Any blame for his uncontrollable actions go directly to his insurance and pharmacy for not putting an effort into keeping him out of the hospital, especially when they discontinue the medication without offering a replacement for him.. The revelation that Pete has no choice in this matter makes him break down sobbing, for obvious reasons.
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Subversion in Scribblenauts. Entering the word "Psycho" spawns a girl with a knife, but like any neutral NPC, she only attacks when frightened and holding a weapon.
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Avatar: The Last Airbender: Azula has always had a penchant for violence, but she was most likely to only use it when it was most needed, to dire effect — an apt comparison to the trick for lightningbending. However, when she goes round the bend, her sadism and violence rocket the hell up. But on the realistic side, she gets considerably less effective when insane. It's doubtful the heroes could have defeated her if she'd stayed sane.
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Ren of The Ren & Stimpy Show is sort of an aversion. He's both insane and violent, there's no questioning that. However, he's only violent when he's being normal; when his psychotic tendencies are triggered, he becomes terrifyingly calm and never lays a mere finger on Stimpy. Instead, he gives elaborate To the Pain monologues. "Stimpy's Fan Club" and "Sven Hoek" contain possibly the best examples of that.
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Danganronpa: Trigger Happy Havoc: Toko Fukawa turns out to have dissociative identity disorder, and naturally their split personality is the sadistic, Laughably Evil serial killer Genocider Syo/Genocide Jack.
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Princess Cyd: Cyd's brother had an unspecified mental illness. He killed their mother and then himself following an intense argument.
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The Borderlands series's iconic psychos, of course. The sequel also has the Crazed Marauders, although it's arguable whether this counts as the regular Marauders are violent enough without being insane.
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Averted on Archer. Cheryl does have violent tendencies, but no more so than most of the comparatively sane members of the cast, and her insanity leads to her hurting herself more often than it does to her hurting others. Krieger is even more obviously insane than Cheryl but shows no violent tendencies at all. Downplayed with Barry Dylan, who becomes much more violent after he goes insane, but it is less of the "randomly attack anything in sight" kind of insanity typical of the trope and more of a burning desire to kill Archer specifically.
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Renegade Shepard can use this trope to justify punching a guy in the face in Mass Effect. He keeps spouting doomsday prophecies, and, well:
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The Ruling Class: Subverted in the first half of the film with Jack Gurney, who downplays the disturbing implications of insanity and is the kind of funny, harmless madman who wouldn't hurt a fly and who is victimised by his own family. In the second half it is their violent assault on his happy world that turns him into a maniac as violent as he is demented.
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Splicers from BioShock are all insane and violent, but they have some excuses, such as still believing there is a war on, addiction to ADAM, and being mentally influenced by the Big Bads. This is disturbingly averted in BioShock 2 where the player can find some splicers who do not attack and just sit there, rocking back and forth.
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The Jackal in Thir13en Ghosts is a terrifying vision of a man in a straight jacket and head cage, a ghost that screams as it approaches people. Played straight and then subverted. The bonus features on the DVD reveal he was a rapist, but deathly afraid of fulfilling this trope again, committing himself to a Bedlam House and willfully choosing to stay there when it burned down, dying in the fire. All of his visible wounds are self-inflicted.
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Averted in Pinky and the Brain. Both of the main characters are heavily implied to be insane, but Pinky is not violent at all, while Brain does often get violent when he's annoyed but never seriously hurts anyone (unless you count unintentionally hurting himself).
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Mass Effect:
Renegade Shepard can use this trope to justify punching a guy in the face in Mass Effect. He keeps spouting doomsday prophecies, and, well:
A sidequest in Mass Effect: Andromeda provides a handwave for why so many supposedly well-screened Andromeda Initiative colonists and employees have gone rogue: it seems an unforeseen side effect of cryogenic suspension caused a neurochemical imbalance in some individuals that makes them more prone to violence. Doctor Lexi develops a drug regimen to counteract it.
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Batman: Batman villains are widely regarded as among the most psychotic and violent in all of comics and thus are serial representatives and offenders of this trope.
This results in part because of Characterization Marches On. The original Batman villains were master criminals typical of pulp villains with no real motivations. The first Joker dressed in white paint and didn't have silly gag-based antics. After the '50s, when comics were subject to Bowdlerization, The Joker became a harmless villain with gag-based antics celebrated in the Adam West show. When Dennis O'Neil, Steve Engelhart, and other writers sought to make the Joker menacing again, they had to justify the gag-based elements which had become The Artifact as well as other motif-themed criminals such as The Riddler which became famous thanks to Batman (1966). Their solution was Hollywood Psych, and they added Arkham Asylum into the mix. Since then, all of Batman's villains were described not merely as supervillains but as psychopaths.
Frank Miller's The Dark Knight Returns partly plays this straight and partly parodies it, by showing how absurd Batman's conflict with supervillains becomes when made into a discourse among the popular psychology and sociological analysis of prime time cable news. Popular psychologists and careerist shrinks like Bart Wolper try to cure the likes of Two-Face via plastic surgery that repairs the bad half of the face. It turns out to be the wrong half; the real Harvey Dent was the scarred-out part of his face, representing his guilt and self-loathing. The book also shows Joker closer to the original Bill Finger characterization as a joyless psychopath who speaks in a Creepy Monotone, although it does this by playing up the Foe Romance Subtext element to whole new heights. Batman himself in Frank Miller's books is shown to be somewhat of a functional madman most of the time.
Alan Moore wrote The Killing Joke in part to reconcile all the elements of the earlier Joker origins with his new characterization as a psychopath, in the process he raised the question of whether Joker can be truly held accountable for his actions on account of his mental illness, whether he can potentially be cured. While the "one bad day" element of Joker and the book's depiction of him as Batman's Shadow Archetype has endured, Moore felt that introducing realistic psychology is pointless with the function that Joker, as an entertaining supervillain, is supposed to perform.
Grant Morrison has repeatedly raised the possibility that, whatever is going on in the Joker's head, it isn't madness as we currently understand it, but something much worse. John Carpenter's Joker: Year of the Villain one-shot is written from the perspective of a young man who is realistically mentally ill, and who comes to realise that he and the Joker are not the same.
Two-Face wasn't evil until one side of his face was ruined and (depending on the version) his insanity either began or became much worse. In fact, most Batman villains tend to fall into this category... with the exception (usually) of Humpty Dumpty, who saved Batgirl from falling off a building, fixed her dislocated shoulder, and went quietly to the asylum.
Mr. Freeze is usually one of the few clear aversions in Batman's rogues gallery despite usually being incarcerated at Arkham because the facility can cater to his odd medical needs, as he's not "mad" in the least and is instead just a cruel pragmatist driven by anger, grief, revenge, and hatred. He was turned into a straight example for the New 52 driven by his obsession with Nora who in this reality he's never known and his delusions of a relationship with her (and then soon reverted to his previous version, since the change was highly unpopular).
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Outlast zig-zags and deconstructs the trope. Mount Massive is meant to be an asylum for insane criminals, but out of the many, many inmates you find throughout the game, surprisingly few are hostile, and among those, some only are so because Murkoff denied them or even went against their treatment in order to use them further in Project WALRIDER.
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Discussed and defied in Devotion. Mei Shin has an anxiety disorder, but it is clear to the viewer that she's a scared little girl who both needs and wants help. However, Feng Yu becomes enraged (due to the social stigma associated with mental illness at the time) when a hospital suggests that Mei Shin sees a psychiatrist because his daughter is "not a lunatic". His ignorance towards Mei Shin's condition turns out to have disastrous consequences.
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Insanity in Star Trek-land seems to consist of attacking people, yelling, having bulging eyes, and sweating a lot. And being played by Morgan Woodward.
Partly justified in the two episodes of TOS featuring asylums — both times they were specified to be for the criminally insane, explaining why these insane people would skew violent even if the overwhelming majority don't. The Tantalus penal colony is for those deemed curable, Elba II is intended for the incurable (by modern Federation science), and dialogue implies it to be the only such installation in the Federation. It has eight patients.
Actually, it is subverted more often than played straight in cases that don't involve asylums for the criminally insane. Most insane characters are dangerous, but not necessarily violent.
In "City on the Edge of Forever" McCoy does act violent, but it is mentioned that the cordrazine overdose that sent him into the breakdown induced severe paranoia - which could, in Real Life, lead to violent behavior. Besides, all the violence he does use is focused on escaping these perceived enemies. Once he lands in the past, he's more confused and scared than violent.
In "Is There in Truth No Beauty?", Marvick, who goes insane after seeing Ambassador Kollos, lands the crew in serious trouble, but not because he's violent - because he's delusional, and managed to send the ship right out of the known galaxy in his terrified escape attempt. Spock, in his temporary bout of insanity due to the same cause, is violent, but then again, Vulcans have been mentioned to have a serious predisposition towards violence which led them to eschew all emotions to avoid destroying themselves.
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Kaeloo: Mr. Cat is an insane psychopath who owns a bunch of weapons and attacks people and objects very violently to the slightest annoyance (or even for no reason at all). Stumpy may be an aversion since he is insane, but not violent. If he is being violent, it's probably in a video game or attacking an object, but not a person.
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Kefka Palazzo from Final Fantasy VI. It says a lot about a character when his madness makes him The Dreaded on both the protagonists' side of the conflicts and the villains'. An NPC in Final Fantasy VI states that Kefka is a Psycho Prototype, having lost his mind after receiving the empire's first experimental Magitek Infusion, and in Dissidia Final Fantasy it's implied that the process has made him unable to feel anything at all, except for when he is giving in to his destructive urges.
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The Undertaker during the Ministry of Darkness angle which is widely considered to be his most evil & violent period. Mark, aka Mark Calaway, (Kayfabe) became lost in The Undertaker gimmick and genuinely believed he was The Lord of Darkness. Vince then points out that not only is he believing, but he has others believing as well.
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I, Claudius manages to subvert this despite featuring the actual Caligula. His violent/psychopathic tendencies are explicitly shown NOT to follow from his psychotic delusions: he's a killer from childhood but doesn't go mad until after he becomes Emperor years later. Livia and other murderous characters are described as "mad" by other characters but are not shown as irrational — even Nero, explicitly called "as mad as... Caligula", is clearly nothing of the kind.
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In Being Human, vampires are shown to be the fantasy equivalent to drug addicts, making them go batshit if they don't get any blood. According to Herrik though, all people are that violent and vampires are just beyond any constraints.
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Shadow of Israphel brings us Templar_Enoch. When he was sane, he wasn't violent, although he was incredibly arrogant. After being driven insane (due to brainwashing from the Sentinels, he murders his fellow Templars, realises what he has done, and then tears his body apart. Later, Lewis Brindley and Simon Lane meet the Evil_Honeydew clone duo, who are both insane and have a love for TNT, due to a malfunctioning cloning machine.
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The Crowded Room: Danny it turns out has split personalities, and had attempted to kill his stepfather Marlin, with the help of Ariana (who's revealed to be his alter), using the Insanity Defense at his trial as a result. It's successful.
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In On Dangerous Ground, Danny Marlden is mentally unstable; therefore, he kills on any given whim.
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In The Wheel of Time series it is stated that any man able to use magic will eventually be turned insane and then they will kill everyone around them. Heck, the world was destroyed by 101 men who saved the world by sealing the Big Bad who then cursed the source of magic, drove them insane, and caused them to rip the world apart in a horrid frenzy of madness and killing.
It's not so much that they're violent as the fact that they have the power to make their insane delusions a reality. While one male channeler may or may not be a problem, over a hundred of them deciding that peaches are poisonous, or that mountains belong there, or that they're 100% certain a hurricane/earthquake is coming, leads to a lot of death and destruction. We get a perfect example of how it works at the end of A Path of Daggers, where a male channeler snaps and remains quite good-natured... but one of the protagonists keeps having to explain to him that he should not collapse the palace they're standing in so that he can use the stones to build a shelter for her.
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Jack Torrence goes violently, and effectively, insane via cabin fever and alcoholism in The Shining, hunting down his terrified family with an axe. This is somewhat justified in the Stephen King novel, as being insane puts him under the hotel's control; that might also be true in the movie, though Stanley Kubrick deliberately leaves it vague. In the TV miniseries remake Stephen King's The Shining, Jack (played by Steven Weber) is more clearly a nasty person only when he's drunk, an aspect King felt Kubrick's film lacked (in Nicholson's portrayal, Jack seems a bit scary even before he falls off the wagon). Problem is, Weber isn't nearly as frightening. As Kubrick said, when some of his actors complained he was pushing them into unrealistic, over-the-top performances: "Real is good. Interesting is better."
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Xenogears has some examples.
Played straight: Id, as Fei is explicitly referenced as having the condition and Id explicitly stated to be an alter.
Played straight: Anyone under the influence of ''Drive'' in the storyline (though not in gameplay) will become violently insane. Elly and an early game antagonist have this happen in-story (with said antagonist trying to kill children in his path), and it's implied Sigurd was a test subject for the drug in his backstory.
Implied: Kahran Ramsus/Carlin Ramses appears to be driven to excessive levels of violence by abandonment and combat trauma and borderline personality traits, although, unlike Fei, he does not have a canonical in-text diagnosis.
Implied: Krelian/Karellen appears to be driven by the desire to force Sophia/Elly to have a relationship with him, then on losing her Sophia incarnation in war, to Gray Goo the entire last remnants of humanity on the planet and become one with "god," as a result of what can be interpreted as extreme narcissism.
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Alpha from Dollhouse appears to be this trope — the composite event that gave him a whole host of imprinted personalities made him into an insane genius and also a psychopathic killer. Actually an aversion, as his original personality was already psychopathic before the composite event, and by the time of "Epitaph Two" has developed a non-insane personality based on all of his component personalities, much like Echo.
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In the Yogscast Minecraft Series, there are the following examples:
Shadow of Israphel brings us Templar_Enoch. When he was sane, he wasn't violent, although he was incredibly arrogant. After being driven insane (due to brainwashing from the Sentinels, he murders his fellow Templars, realises what he has done, and then tears his body apart. Later, Lewis Brindley and Simon Lane meet the Evil_Honeydew clone duo, who are both insane and have a love for TNT, due to a malfunctioning cloning machine.
Duncan Jones is revealed to have an evil clone in the form of "Lalnable Hector". He's described as being mentally insane and apparently has a love of butchering testificates.
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Invoked, but averted, in To Kill a Mockingbird. Boo Radley isn't violent (and may or may not be insane), but the reader's introduction to him is via a story where he stabbed his father with scissors with no provocation.
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Psycho: Norman Bates seems harmlessly socially awkward at first, but he is gradually revealed to be a dissociating murderer.
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Cyberpunk 2013/2020 has "Cyberpsychosis" which happens when an already unstable mind becomes even more unstable with too many cybernetics. In-game, each piece of cybernetics reduces your "Empathy" stat (similar to Shadowrun's "Essence" stat) and with each loss of Empathy, the Player Character becomes more distant to people and start to relate more to machines until every little interaction with a living person can drive them over the Edge and become murderous sociopaths that need to be taken away by the local Psycho Squad to under-go mandatory therapy. With each session of therapy, the Player Character gains two points of Empathy.
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Blindspot: Background on a jewel thief caught when a heist goes south reveals he was diagnosed as "highly intelligent and utterly amoral" (a fancy way of saying "sociopath"). The Navy scooped him up and turned him into a SEAL for black ops (Agent Reade makes a snide remark about "adding honor and duty to that list"), but when he and his unit mustered out they just turned to armed robbery.
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Partly justified in the two episodes of TOS featuring asylums — both times they were specified to be for the criminally insane, explaining why these insane people would skew violent even if the overwhelming majority don't. The Tantalus penal colony is for those deemed curable, Elba II is intended for the incurable (by modern Federation science), and dialogue implies it to be the only such installation in the Federation. It has eight patients.
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 Star Trek: The Original Series
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The Elder Scrolls series' backstory has Emperor Pelagius the Mad. Living up to his nickname, he was both utterly insane and, especially later in his life, prone to outbursts of Ax-Crazy violence due to his insanity. After his madness became too publicly apparent, he was institutionalized and died only a few years later.
The Mad God Sheogorath can go from friendly and helpful to savage and murderous mid-sentence. In one of his myths he "helped" a woman commenting on the beauty of bird songs by gifting humanity with music... by killing her and using instruments made from her body. His plane of Oblivion, shown in the Shivering Isles DLC for Oblivion mostly averts this though. While all of the inhabitants of the Shivering Isles are completely insane, it's mostly in ways that are either harmless or only really harmful to themselves, with only a handful being a real danger to anyone. And while Sheo himself will threaten you quite luridly, the only way to get him to actually act on any of it is to attack him, which will cause him to calmly get up and kill you by teleporting you high above the ground and letting you fall.
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Subverted in Joker (2019). At the beginning of the film, Arthur Fleck is living with mental illness, but he's a peaceful man just trying to get by. His illness is not what drives him to violence; instead, he turns violent due to many citizens of Gotham abusing him for no apparent reason (as mentioned above, the mentally ill are often susceptible to physical harm). Furthermore, while he's initially checking in with a social worker and taking medications at the start of the film, he loses access to both due to budget cuts, which exacerbates Arthur's already bad situation. That's just the beginning.
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Murder, She Wrote: In "Shear Madness", George got declared insane and sent to a mental hospital after apparently murdering Ann's first groom, and when Bill Sanders dies under similar circumstances, he once again becomes the primary suspect. However, George turns out to be neither insane nor violent.
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Chiri Kitsu of Sayonara, Zetsubou-Sensei started out as mostly a Control Freak / Neat Freak, but over time becomes defined by violent psychopathy and is presented as a Serial Killer.
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 Sayonara, Zetsubou-Sensei (Manga)
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Tintin: Zig-Zagged, as a plot point in one of the biggest story arcs (Cigars of the Pharaoh — Blue Lotus) is the Rajijah juice, a poison that causes madness. Several characters are driven mad by this poison, and the most common symptoms are just that they become a total Cloud Cuckoolander. Only two characters driven mad by this show any violent tendencies — Professor Sarcophagus, who was influenced by a Fakir after having already gone mad, and Didi, who encourages people to find the way, and says he'll cut off their head. However, he is eventually cured, though not much is known about the other victims of the Rajijah Juice.
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Discussed in the Modesty Blaise novel I, Lucifer. The man called "Lucifer" is psychotic in the strict sense, afflicted with frequent hallucinations and a delusional belief system, but is amiable and not at all inclined to violence. When Stephen says of the villains that they're "as mad as Lucifer", Modesty tells him sharply that unlike Lucifer they have no trouble distinguishing what's real or telling right action from wrong action; they've made a deliberate choice to be harmful.
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Many characters in the Twisted Metal franchise. Especially in Black where the entire cast has been broken out of an asylum and allowed to fight each other for the right to have their wish come true. This usually involves murder of some kind.
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Neverending Nightmares has the patients in the "Insanity" segment of the game, who will literally rip Thomas's throat out with their teeth if he gets too close or they hear him walking around. Justified as the patients appear to have been horribly abused: they're bruised and battered, lobotomized, bound in straitjackets, and have had their eyes sewn shut.
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Peeta in Mockingjay when he is Brainwashed and Crazy. The first thing he does when he sees Katniss is try to strangle her. It is justified in that the brainwashing was specifically done to turn him against Katniss and make him want to do violent things to her.
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The Marauders from Mage: The Ascension are Mages who went insane via mundane or magical means. In this setting, how a Mage perceives the world and believes how it should work is what changes reality. With hallucination and delusion, this becomes... somewhat skewed. The Marauders' existence itself is violence upon reality.
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Ms. 45: After she's raped twice in the same day, Thana understandably has a mental breakdown, first killing men she finds threatening, later just men period.
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In Six Feet Under, the one character who is bipolar is also psychopathic and tries to carve off the tattoo on his sister's back, after slicing off his own.
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Spider-Man: When Harry Osborn became the second Green Goblin, he was not under influence of the Goblin Serum (though it was later retconned that his father did give him some), but merely under the influence of drugs and insanity.
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Dean Ambrose acts like a crazed animal.
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 Jon Moxley (Wrestling)
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Zeno Clash has a Double Subversion. Ghat notes that the Corwids aren't necessarily dangerous, because they just do whatever they want. Then they decided that what they want to do is attack Ghat, and possibly eat him.
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In Split, Kevin is a man with 23 alternate personalities, 20 of whom are perfectly harmless. Unfortunately, the plot kicks off when the three that are an actual danger to others manage to seize control. It's then taken much further when these three succeed in creating a 24th personality, "The Beast".
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Flesh and Bone: At first Romeo seems a little delusional, but otherwise harmless and kind. In the last episode, he becomes convinced that Bryan is a "dragon" he has to slay and does so.
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The Vision (2015):
A series of traumas undermine Virginia's mental health, and by the middle of the series, it's clear that something is psychologically wrong with her. She later kills Victor out of revenge for Victor's accidental murder of her son, then savagely kills Sparky as part of a magical formula.
Victor Mancha has a vibranium addiction, which has had a detrimental effect on his mental health. Victor accidentally kills his nephew Vin while high on vibranium, despite vibranium supposedly being a painkiller for robots.
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Subverted in Wolfenstein: The Old Blood. A Nazi occultist has driven numerous patients mad in order to question them about their new psychic dreams, and stashes them in a prison ward where they wander unconfined. Most of them completely ignore B.J. when he cuts through after escaping another part of the prison, but one mistakes him for a relative and grabs him - and B.J. gently pushes him away, and the inmate withdraws a little and lets him go, saying "I thought... for a second..." B.J. then reflects that he's reminded of an aunt who had dementia.
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 Wolfenstein: The Old Blood (Video Game)
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Warhammer and Warhammer 40,000: pretty much anyone corrupted by Chaos. And seeing as the Blood God Khorne is the incarnation of rage... Then again, it could be argued that everyone in this universe is insane and violent to varying degrees.
Inverted by the Necron lord Nemesor Zahndrekh. Zahndrekh was driven insane by the reanimation process and so still believes he's a living, flesh and blood being, still fighting the inter-dynasty wars of his youth. However, he's less violent for it, as he still believes in old articles of war such as taking prisoners. His long-suffering bodyguard Oberyn (who is perfectly sane and undeluded) is the one who kills these prisoners before regretfully informing his boss that the prisoners were killed while trying to escape. Again.
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Team Fortress 2: In "Meet the Pyro", the other classes talk about how scary they are, cut with images of them causing horrible destruction. However, when we see the Pyro's view, it turns out they see the world as a colorful wonderland where they're bringing candy and happiness to the other classes. Of course, the real-world effects of the Pyro's insanity are the same.
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The degree to which the various incarnations of the Master from Doctor Who are portrayed as "insane" has varied over the years, but they're all definitely evil. The first one isn't referred to as "mad" until his fourth story, at which point he cheerfully accepts the descriptor. By contrast, insanity is used as a Freudian Excuse for John Simm's portrayal. The most recent Master, or Mistress, admits she's "bananas", but her madness is not played as either a cause of or an excuse for her villainous deeds.
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 Doctor Who
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Jake in 11/22/63 apparently believes this. He is certain that Johnny is a danger to Sadie's life, even though he just seems to suffer from some kind of obsessive-compulsive disorder that, while it certainly makes him behave like an emotionally abusive Jerkass, should not immediately translate into being homicidal. He turns out to be right, mind you. He also refers to Oswald as one of "the crazies," who he seems to consider violent per definition.
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JAG: Averted in "The Martin Baker Fan Cub", where only one of the four escaped mental patients from a VA hospital exhibits violent behavior (by grabbing a sidearm from a police officer) and two others are completely harmless with the mental acuity of small children.
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A variation appears in Survival of the Fittest with those who play the game, especially since many are eventually driven insane, if they didn't start out that way. By necessity, "players" are distrustful and hostile towards everyone else, as they aim to be the winner and Sole Survivor, and many attack all other people on sight. Sometimes this verges on Chaotic Stupid behaviour.
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Averted in Criminal Minds, where Reid points out that the insane are less likely to be violent, but that when they are, it's usually a lot worse than normal violence. Like in "With Friends Like These...". Reid's mother is also schizophrenic and lives full-time in an institution but has never hurt anyone. Of course, it's a shorter list of the number of criminals on Criminal Minds who aren't mentally ill, and as it's almost never pointed out the majority of them are non-violent, this comes off a bit flat to some.
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In American McGee's Alice, the whole plot of the game is about violently abusing and protecting yourself from the mutated enemies seen as mere small cartoons in the book.
The second game is an aversion. Alice is violent in her fantasies but almost completely helpless in real life. The only time she actually hurts someone in the real world is when she pushes Bumby into the path of an oncoming train at the very end of the game which, chances are, the player would too if they could.
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Accused: Stephen is a paranoid schizophrenic. His delusions lead him to stab his stepmother, believing she killed his mother, his dog, and is trying to do his father and brother in as well. Somewhat justified with his condition, as the belief they're being persecuted is more likely to make the person use violence (which like Stephen they may honestly believe is self-defense or defense of others).
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There's quite a few characters in Oz that fall under this.
Subverted by Beecher after he goes insane. He becomes feared within the prison for his viciousness, but he only ever is violent in self-defense.
Played straight by Adebisi, who is clearly unhinged and gleefully violent for the sake of it at times.
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Played straight and averted in Pyrrhic with some of the students. As a part of the experiment, they are forced to kill, but others were already verging on crazy before it. Some, like Tyra, thought that they were vampires, while others like Jackson have begun to disassociate from reality due to what is heavily implied to be Danson messing with his mind. However, Jackson's is treated with respect, due to the circumstances and was perfectly sane before the experiment. Others like Marie play this straight.
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Played straight with the mental construct of Kouma Kishima in Kagetsu Tohya, but averted for the most part with the real one. While he is quite non-neurotypical, his violent moments are reserved for situations where most people would be (i.e. watching assassins kill your family, getting shot in the head, etc.)
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 Tsukihime (Visual Novel)
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Oathbringer (third book of The Stormlight Archive): Averted with the Fused, who are exactly the people you would expect to play it straight due to their connection with the local God of Evil. The insane Fused are kinda weird and useless, spending most of their time staring at nothing and giggling. Even their human slaves aren't scared of them. They are still useful in battle, however.
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Sick Sad World: Subverted. When talking about the Sandy Hook shooter, Dev and Jasmine note that his mental illness alone didn’t account for the murders he committed.
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In the Buffy the Vampire Slayer/Angel universe, Faith, after coming out of her coma and going rampaging, is repeatedly referred to as "psychotic", with direct reference to her violence. In fact, however, she shows no signs of delusions: she's on the edge of mental breakdown rather than past that point. When she does tip over, first temporarily while fighting Buffy-in-Faith's-body, then again when fighting Angel, the immediate effect is to make her more violent — but the first time she basically thinks she's beating up herself, and the second time she's trying to provoke Angel into killing her — a stark contrast to the torture, beatings, and attempted murder that mark her behavior when she's lucid! Furthermore, the second breakdown leads directly to her letting Angel help her, and therefore to her redemption.
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Bray Wyatt initially was just a possibly-demonically-possessed, ax-crazy, backwoods cult leader who spoke in dark, cryptic riddles and preached sermons about death and destruction on a nearly weekly basis. As the Fiend, he is a Monster Clown who is even more sadistic.
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A few characters in Elfen Lied, namely Lucy and Mariko. And the cruel kids from Lucy's past who were clearly psychopaths who beat Lucy's dog to death while making her watch to get a reaction out of her.
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Himmelsdalen: Subverted. Although all of the patients are dangerous sociopaths who have been sentenced to life for crimes in various countries, it's mentioned that even those with their condition are not always so. Many only commit nonviolent crimes, with captains of industry and politicians specifically mentioned to often be sociopaths.
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River Tam from Firefly is psychotic, violent — and a protagonist. Her violence is directed at the bad guys (and also, for reasons that might have become clear if the series had continued, at anything with a Blue Sun logo). Before the experiments that made her psychotic, she was a normal, nonviolent (if extremely gifted) young girl. An example of a Justified Trope, since the aim of the experiments was to create a Super-Soldier, and violence kind of comes with the package.
Also justified because they removed bits of her brain, including one part that was supposed to let her push things that upset or bothered her out of mind. So basically she's a psychic supersoldier who is totally incapable of ignoring something that causes her distress.
The Reavers are also a trope. "Bushwhacked" gives us the descent of someone exposed to their brand of madness (revealed in the movie to be the Pax they were exposed to, which subverts the trope some 99% of the time where Insane Equals So Apathetic You Dehydrate To Death Because You Just Don't Feel Like Getting A Drink Of Water).
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Averted by the titular character in Goblin Slayer. A few characters note that he's an obsessive freak who's not all there, and even Cow Girl's uncle warns her to keep her distance as the boy she knew back then is gone. But Goblin Slayer remains calm and cordial in his relationships, and at the end of the day, he's still a trusted Silver-rank member of the Adventurer's Guild.
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Family Guy: In "The Fat Guy Strangler", Lois' long-lost brother Patrick has spent his life in an insane asylum after walking in on his mother giving Jackie Gleason head when he was younger. Unfortunately, it doesn't seem to have done Patrick any good, as he still has a lingering hatred of fat men that (thanks to Peter pushing his Trauma Button) eventually leads him on a killing spree.
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A sidequest in Mass Effect: Andromeda provides a handwave for why so many supposedly well-screened Andromeda Initiative colonists and employees have gone rogue: it seems an unforeseen side effect of cryogenic suspension caused a neurochemical imbalance in some individuals that makes them more prone to violence. Doctor Lexi develops a drug regimen to counteract it.
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Insane Equals Violent
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In Sword Art Online, this seems to be a dime a dozen for the villains, so much so that if you're a villain, you're also Ax-Crazy. Not only are they violent but are also psychotic to varying degrees, such as Vassago Casals/PoH, the Death Gun trio, and Gabriel Miller/Subtilizer.
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Insane Equals Violent
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Mick Foley has multiple personalities, all of which display their own individual mental illnesses or abnormalities.
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Many of the bosses in the game Dead Rising are mall workers whose cheese slid off their collective cracker during a Zombie Apocalypse. The violence is justified, as those whose reaction tended more towards rocking quietly in a corner were probably turned into hamburger very quickly.
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An apparent invocation of this trope saw a British psychiatric charity condemn Manhunt 2, despite the lead character — and most of the enemy characters — not actually being insane at all. The Japanese release of Dementium: The Ward was met similarly.
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BlazBlue:
Yuuki Terumi. though he can come across as quite affable and contained in his Hazama guise, can also completely lose his shit at the drop of a hat. It also slips into gameplay; while he's in his Hazama guise, his fighting style most of all looks like Michael Jackson-ish dance moves and, for some fridge brilliant characterization integration, revolves around baiting the opponent into making mistakes, perfectly fitting his Manipulative Bastard tendencies. When he lets loose for real, though, his fighting-style switches to sheer Sadistic Video Game Cruelty Potential with few defensive options but some of the highest damage outputs in the game when on the offensive. Come the fourth game in the series, it's revealed that he's actually Takehaya Susanoo no Mikoto, Jerkass God extraordinaire, and though he lays off the Maniacal Laughing madness for a while, his ultimate goal of usurping the Master Unit: Amaterasu and turning reality into a cesspool of terror and despair where everyone kills each other on loop reveals that he's way more insane than previously believed.
The Yukianesa has had a detrimental effect on Jin Kisaragi's mental health, which manifests in his murderous and psychotic rage that pops up whenever he's near Ragna or Noel. As Jin overcomes the weapon's influence across the series, he also acts noticeably less violent and psychotic and is able to better function in battle.
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After the main character of The Chronicles of Professor Jack Baling goes crazy trying to unlock the secrets of his student's perpetual motion machine, he ends up building a death ray. Violence ensues.
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When Freeze Man from In Wily's Defense went insane, he started killing people for the fun of it, despite his being a robot and therefore breaking the rules.
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The main characters of Assassins are all this trope to some extent. Justified, however, in that they're all Real Life people who were crazy enough to try to kill a US President, some more successful than others.
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Space 1889 played straight the vast majority of NPCs with the motivation “insane� are violent and hostile to the player characters.
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In Asylum: Blackout, most of the inmates seem to be non-violent. Unfortunately, the ones who aren't are more than enough to dispatch the skeleton crew of workers.
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Deadpool: Deadpool becomes more unhinged than usual during the Black Box story arc of Cable & Deadpool. Even though he can't remember it later, it is revealed that he murdered a terrorist who was living on Cable's island. When asked why he did it, he replies that he doesn't know. Since his mind is more out-of-whack than usual, he just killed for no reason. However, Deadpool was pointlessly violent long before he was portrayed as insane.
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All of the insane asylum residents in Kathryn Hulme's The Nun's Story embody this trope to some degree. The Archangel Gabriel attempts to rape Sister Luke, and another inmate, who is never caught, murders one of the nuns. Even the Abbess (who, much to Sister Luke's surprise, turns out to have been an actual abbess), turns violent when thwarted. It is implied that this is a special asylum for the dangerously insane.
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Averted in Cracked (2013) a show about a team of police officers and psychiatric professionals assigned to deal with crimes involving the mentally ill. While many of the perpetrators are disturbed individuals, there have also been cases where insane people have been witnesses or victims, including a bipolar psychotic who saw a girl he had been trying to help get murdered, and a boy with Tourettes who tried to find assistance for an abandoned baby.
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The following is a list of statements referring to the current page from other pages.

 Insane Equals Violent
processingCategory2
Cynicism Tropes
 Insane Equals Violent
processingCategory2
Discredited Trope
 Insane Equals Violent
processingCategory2
Hollywood Psych
 Insane Equals Violent
processingCategory2
Madness Tropes
 Insane Equals Violent
processingCategory2
Stereotype
 Insane Equals Violent
processingCategory2
Villains
 Insane Equals Violent
processingCategory2
Violence Tropes
 Batman (Comic Book) / int_e57c714d
type
Insane Equals Violent
 Batman: Year One (Comic Book) / int_e57c714d
type
Insane Equals Violent
 D.R. & Quinch (Comic Book) / int_e57c714d
type
Insane Equals Violent
 Les Tuniques Bleues (Comic Book) / int_e57c714d
type
Insane Equals Violent
 Asylum / Fan Fic
seeAlso
Insane Equals Violent
 Breaking Point / Fan Fic
seeAlso
Insane Equals Violent
 Harmony's Warriors (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Phylactery / Fan Fic / int_e57c714d
type
Insane Equals Violent
 Shinra High SOLDIER / Fan Fic / int_e57c714d
type
Insane Equals Violent
 Asylum (Daemon of Decay) (Fanfic) / int_e57c714d
type
Insane Equals Violent
 At The Food Court (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Breaking Point (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Evangelion Gear (Fanfic) / int_e57c714d
type
Insane Equals Violent
 For His Own Sake (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Forum of Thrones (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Fox-Face and Flames (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Nymeria's War (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Owls and Souls, Witches and Resonance (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Remnant Inferis: DOOM (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Sylvia the Sylveon (Fanfic) / int_e57c714d
type
Insane Equals Violent
 The King Nobody Wanted (Fanfic) / int_e57c714d
type
Insane Equals Violent
 The Pirate Pegasus (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Warbound Widow (Fanfic) / int_e57c714d
type
Insane Equals Violent
 What If Freeza Turned Good? (Fanfic) / int_e57c714d
type
Insane Equals Violent
 What If Frieza Turned Good? (Fanfic) / int_e57c714d
type
Insane Equals Violent
 With Pearl and Ruby Glowing (Fanfic) / int_e57c714d
type
Insane Equals Violent
 Bereavement / int_e57c714d
type
Insane Equals Violent
 Bird Box / int_e57c714d
type
Insane Equals Violent
 Bug (2006) / int_e57c714d
type
Insane Equals Violent
 Criminally Insane / int_e57c714d
type
Insane Equals Violent
 Halloween (2018) / int_e57c714d
type
Insane Equals Violent
 Halloween Kills / int_e57c714d
type
Insane Equals Violent
 Joker (2019) / int_e57c714d
type
Insane Equals Violent
 Maria Labo / int_e57c714d
type
Insane Equals Violent
 Ms. 45 / int_e57c714d
type
Insane Equals Violent
 Night of the Ghouls / int_e57c714d
type
Insane Equals Violent
 Old / int_e57c714d
type
Insane Equals Violent
 Ophelia / int_e57c714d
type
Insane Equals Violent
 Poor Albert & Little Annie / int_e57c714d
type
Insane Equals Violent
 Princess Cyd / int_e57c714d
type
Insane Equals Violent
 Psycho / int_e57c714d
type
Insane Equals Violent
 Saint Maud / int_e57c714d
type
Insane Equals Violent
 Serenity / int_e57c714d
type
Insane Equals Violent
 Serenity (2005) / int_e57c714d
type
Insane Equals Violent
 Sexy Evil Genius / int_e57c714d
type
Insane Equals Violent
 Shock Corridor / int_e57c714d
type
Insane Equals Violent
 Silent Night, Deadly Night / int_e57c714d
type
Insane Equals Violent
 Silver Linings Playbook / int_e57c714d
type
Insane Equals Violent
 Split / int_e57c714d
type
Insane Equals Violent
 Strange Days / int_e57c714d
type
Insane Equals Violent
 Summer of Sam / int_e57c714d
type
Insane Equals Violent
 The Batman (2022) / int_e57c714d
type
Insane Equals Violent
 The Cabinet of Dr. Caligari / int_e57c714d
type
Insane Equals Violent
 The House That Jack Built / int_e57c714d
type
Insane Equals Violent
 The Nun's Story / int_e57c714d
type
Insane Equals Violent
 The Quiet Earth / int_e57c714d
type
Insane Equals Violent
 The Touch of Satan / int_e57c714d
type
Insane Equals Violent
 The Visit / int_e57c714d
type
Insane Equals Violent
 The Voices / int_e57c714d
type
Insane Equals Violent
 Vampire's Kiss / int_e57c714d
type
Insane Equals Violent
 Baldur's Gate (Franchise) / int_e57c714d
type
Insane Equals Violent
 The King of Fighters (Franchise) / int_e57c714d
type
Insane Equals Violent
 Tintin (Franchise) / int_e57c714d
type
Insane Equals Violent
 Bony / int_e57c714d
type
Insane Equals Violent
 Denpa Teki na Kanojo / int_e57c714d
type
Insane Equals Violent
 Drenai / int_e57c714d
type
Insane Equals Violent
 11/22/63 / int_e57c714d
type
Insane Equals Violent
 Everybody Loves Large Chests / int_e57c714d
type
Insane Equals Violent
 Final Girls / int_e57c714d
type
Insane Equals Violent
 House of Leaves / int_e57c714d
type
Insane Equals Violent
 Jane Eyre / int_e57c714d
type
Insane Equals Violent
 Modesty Blaise / int_e57c714d
type
Insane Equals Violent
 Oathbringer / int_e57c714d
type
Insane Equals Violent
 Swan Song / int_e57c714d
type
Insane Equals Violent
 The Creeping Charlies / int_e57c714d
type
Insane Equals Violent
 The Many Lives of Stephen Leeds / int_e57c714d
type
Insane Equals Violent
 The Shards / int_e57c714d
type
Insane Equals Violent
 The Thirteenth Tale / int_e57c714d
type
Insane Equals Violent
 The Trojan Cycle / int_e57c714d
type
Insane Equals Violent
 Thief of Time / int_e57c714d
type
Insane Equals Violent
 This Sunday / int_e57c714d
type
Insane Equals Violent
 To Kill a Mockingbird / int_e57c714d
type
Insane Equals Violent
 Water for Elephants / int_e57c714d
type
Insane Equals Violent
 CirqueDuNie
seeAlso
Insane Equals Violent
 Malchus
seeAlso
Insane Equals Violent
 TheInterferenceLegends
seeAlso
Insane Equals Violent
 TheSentry
seeAlso
Insane Equals Violent
 I Am a Hero (Manga) / int_e57c714d
type
Insane Equals Violent
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type
Insane Equals Violent
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type
Insane Equals Violent
 Magi: The Labyrinth of Magic (Manga) / int_e57c714d
type
Insane Equals Violent
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type
Insane Equals Violent
 Graduation Hall (Roleplay) / int_e57c714d
type
Insane Equals Violent
 Ink City (Roleplay) / int_e57c714d
type
Insane Equals Violent
 Accused / int_e57c714d
type
Insane Equals Violent
 Aishiteru / int_e57c714d
type
Insane Equals Violent
 American Horror Story: Asylum / int_e57c714d
type
Insane Equals Violent
 American Horror Story: Cult / int_e57c714d
type
Insane Equals Violent
 Awake (2012) / int_e57c714d
type
Insane Equals Violent
 Channel Zero / int_e57c714d
type
Insane Equals Violent
 Cracked (2013) / int_e57c714d
type
Insane Equals Violent
 Dark Angel / int_e57c714d
type
Insane Equals Violent
 Defiance / int_e57c714d
type
Insane Equals Violent
 Evil (2019) / int_e57c714d
type
Insane Equals Violent
 Firefly / int_e57c714d
type
Insane Equals Violent
 Flesh and Bone / int_e57c714d
type
Insane Equals Violent
 Fringe / int_e57c714d
type
Insane Equals Violent
 Hard Sun / int_e57c714d
type
Insane Equals Violent
 Hit & Miss / int_e57c714d
type
Insane Equals Violent
 Homicide: Life on the Street / int_e57c714d
type
Insane Equals Violent
 JAG / int_e57c714d
type
Insane Equals Violent
 Last Week Tonight with John Oliver / int_e57c714d
type
Insane Equals Violent
 Marcella / int_e57c714d
type
Insane Equals Violent
 Misfits / int_e57c714d
type
Insane Equals Violent
 Mom / int_e57c714d
type
Insane Equals Violent
 Perception (2012) / int_e57c714d
type
Insane Equals Violent
 7 Days (1998) / int_e57c714d
type
Insane Equals Violent
 Strange Empire / int_e57c714d
type
Insane Equals Violent
 The Caesars / int_e57c714d
type
Insane Equals Violent
 The Crowded Room / int_e57c714d
type
Insane Equals Violent
 The Method / int_e57c714d
type
Insane Equals Violent
 The Practice / int_e57c714d
type
Insane Equals Violent
 The Woman in the House Across the Street from the Girl in the Window / int_e57c714d
type
Insane Equals Violent
 William of Orange / int_e57c714d
type
Insane Equals Violent
 Changeling: The Lost (Tabletop Game) / int_e57c714d
type
Insane Equals Violent
 Space 1889 (Tabletop Game) / int_e57c714d
type
Insane Equals Violent
 Arsenic and Old Lace (Theatre) / int_e57c714d
type
Insane Equals Violent
 Assassins (Theatre) / int_e57c714d
type
Insane Equals Violent
 Bacchae (Theatre) / int_e57c714d
type
Insane Equals Violent
 Harvey (Theatre) / int_e57c714d
type
Insane Equals Violent
 35MM: A Musical Exhibition (Theatre) / int_e57c714d
type
Insane Equals Violent
 Alice: Madness Returns (Video Game) / int_e57c714d
type
Insane Equals Violent
 Crusader Kings (Video Game) / int_e57c714d
type
Insane Equals Violent
 Cube Escape (Video Game) / int_e57c714d
type
Insane Equals Violent
 Darkwood (Video Game) / int_e57c714d
type
Insane Equals Violent
 Dead Space 2 (Video Game) / int_e57c714d
type
Insane Equals Violent
 Devotion (Video Game) / int_e57c714d
type
Insane Equals Violent
 Dream Of Gluttony (Video Game) / int_e57c714d
type
Insane Equals Violent
 Edna & Harvey: The Breakout (Video Game) / int_e57c714d
type
Insane Equals Violent
 Encased (Video Game) / int_e57c714d
type
Insane Equals Violent
 Encased RPG (Video Game) / int_e57c714d
type
Insane Equals Violent
 Loaded (Video Game) / int_e57c714d
type
Insane Equals Violent
 Maid Of Sker (Video Game) / int_e57c714d
type
Insane Equals Violent
 Manhunt (Video Game) / int_e57c714d
type
Insane Equals Violent
 Marathon (Video Game) / int_e57c714d
type
Insane Equals Violent
 Monster Madness (Video Game) / int_e57c714d
type
Insane Equals Violent
 Neverending Nightmares (Video Game) / int_e57c714d
type
Insane Equals Violent
 Perfect Dark (Video Game) / int_e57c714d
type
Insane Equals Violent
 Pokémon Mystery Dungeon (Video Game) / int_e57c714d
type
Insane Equals Violent
 Prison Architect (Video Game) / int_e57c714d
type
Insane Equals Violent
 Psychonauts (Video Game) / int_e57c714d
type
Insane Equals Violent
 Shadow of the Comet (Video Game) / int_e57c714d
type
Insane Equals Violent
 Spooky's Jump Scare Mansion (Video Game) / int_e57c714d
type
Insane Equals Violent
 The Dig (Video Game) / int_e57c714d
type
Insane Equals Violent
 The Reckoning (Video Game) / int_e57c714d
type
Insane Equals Violent
 Theresia: Dear Emile (Video Game) / int_e57c714d
type
Insane Equals Violent
 Wolfenstein: The Old Blood (Video Game) / int_e57c714d
type
Insane Equals Violent
 Xenogears (Video Game) / int_e57c714d
type
Insane Equals Violent
 Yakuza: Like a Dragon (Video Game) / int_e57c714d
type
Insane Equals Violent
 Zeno Clash (Video Game) / int_e57c714d
type
Insane Equals Violent
 Outlast / Videogame / int_e57c714d
type
Insane Equals Violent
 The Dig (1995) (Video Game) / int_e57c714d
type
Insane Equals Violent
 Chaos;Head (Visual Novel) / int_e57c714d
type
Insane Equals Violent
 Echo (Visual Novel) / int_e57c714d
type
Insane Equals Violent
 Higurashi: When They Cry (Visual Novel) / int_e57c714d
type
Insane Equals Violent
 Radical Dreamers (Visual Novel) / int_e57c714d
type
Insane Equals Violent
 Steins;Gate (Visual Novel) / int_e57c714d
type
Insane Equals Violent
 The Haunting of Braidwood Manor (Visual Novel) / int_e57c714d
type
Insane Equals Violent
 Alfred's Playhouse (Web Animation) / int_e57c714d
type
Insane Equals Violent
 Boots to Reboots (Web Video) / int_e57c714d
type
Insane Equals Violent
 Cinema Therapy (Web Video) / int_e57c714d
type
Insane Equals Violent
 Failboat (Web Video) / int_e57c714d
type
Insane Equals Violent
 HeyyItsKris (Web Video) / int_e57c714d
type
Insane Equals Violent
 Out-of-Placers (Webcomic) / int_e57c714d
type
Insane Equals Violent
 SMGPMD (Webcomic) / int_e57c714d
type
Insane Equals Violent
 Stalker x Stalker (Webcomic) / int_e57c714d
type
Insane Equals Violent
 The Powerpuff Girls Reimagined (Webcomic) / int_e57c714d
type
Insane Equals Violent
 Springhole (Website) / int_e57c714d
type
Insane Equals Violent
 Batman: Gotham by Gaslight / int_e57c714d
type
Insane Equals Violent
 Beast Wars / int_e57c714d
type
Insane Equals Violent
 Donald Duck / int_e57c714d
type
Insane Equals Violent
 Dragons: Riders of Berk / int_e57c714d
type
Insane Equals Violent
 Fun and Fancy Free / int_e57c714d
type
Insane Equals Violent