By Praveen R. Kambam, Vasilis K. Pozios and H. Eric Bender of Broadcast Thought

Serial killers simultaneously frighten and fascinate. Whether following media coverage of the Long Island Serial Killer or watching Dexter, the public possesses a seemingly insatiable appetite for the macabre.

Comic book fans are no strangers to stranglers and other killers. Batman’s notorious rogues’ gallery boasts multiple serial murderers among its members. While some of these fictional characters reflect real-life aspects of serial murder, others perpetuate long-standing misconceptions.

The FBI defines serial murder as “the unlawful killing of two or more victims by the same offender(s) in separate events.” Specific motives for murder are commonly seen in the offender: sexual gratification, anger, thrill, attention and the alleviation of anxious urges, among others. Serial killers may also demonstrate a modus operandi, ritualized behaviors or signature aspects; for example, a killer may manipulate or mutilate the body after a murder.

Sometimes comics characters mimic the hideous acts of real-world serial killers. In the story arc “The Last Arkham,” by Alan Grant and Norm Breyfogle (from Batman: Shadow of the Bat, Issues No. 1 to 4), Mr. Zsasz positions his victims’ bodies in lifelike poses. In real life, one victim of Gary Leon Ridgway, aka the Green River Killer, was found fully clothed, with two fish placed on her chest, a wine bottle on her stomach and sausages in her hands.

Some serial murderers keep trophies of their kills. In Batman: Cacophony, by Kevin Smith and Walt Flanagan, Onomatopoeia displays in his “man cave” masks of the heroes he has killed. Real-life serial killer Ed Gein fashioned trophies from the remains of his victims; a mounted human head was discovered in Gein’s possession, ready to be hung.

Scientific and legal jargon can contribute to confusion about serial murderers, their methods and their motives. By analyzing fictional characters, we at Broadcast Thought passionately educate audiences about mental health topics and excite them to learn more about mental illness. We’ll be discussing these ideas Thursday during “Detecting Deviants in the Dark Night: Profiling Gotham City’s Serial Killers,” our panel at Comic-Con International.

How do we fit into the entertainment world? With our expertise as physicians specializing in forensic psychiatry, we offer a unique opportunity for collaboration with writers and other creators to add nuance and realism to characters and storylines that can make them even more compelling. This is our attempt to cast these fascinating characters in a new light, reinvigorate them, and help keep these beloved characters fresh to both old fans and new readers alike.

In real life, serial killers — which commit less than 1 percent of murders in any given year — commonly exhibit characteristics of psychopathy, a collection of behaviors and personality traits that often reflect a callous, uncaring nature. However, Batman villains depicted as psychopathic serial murderers are often incorrectly referred to as “psychotic” rather than “psychopathic.”

“Psychosis,” or experiencing a “psychotic” disorder, refers to a break from reality and is often characterized by disorganized thinking and behavior, hallucinations and/or delusions. Such psychotic symptoms are not commonly seen in the majority of real-life serial murderers and are also not typically depicted in the Batman comics.

An exception is the depiction of the villain Mr. Zsasz in Smith’s Batman: Cacophony. Here, Mr. Zsasz experiences symptoms consistent with psychosis, such as racing, jumbled thoughts and the apparent delusion that he is able to both “free” his victims from their current life of misery and send them to a better existence by murdering them. Although such a depiction of a psychotically derived motive is plausible, it is not representative of the majority of serial murderers in the real world.

In fact, many assume that if someone commits murder serially or in a particularly bizarre or gruesome manner, then the perpetrator must be “crazy” or “insane.” While it is not considered normal — or acceptable — human behavior to engage in acts of serial murder, this behavior, in itself, does not mean that mental disorders, such as mood disorders or psychotic disorders, either directly cause serial murders or contribute considerably to the development of serial murderers.

So, if serial murderers are not, by and large, mentally ill, then why are they so frequently labeled “insane” in the Batman comic books? Many people use “insane” colloquially, but “insanity” is not a psychiatric diagnosis. Rather, “insanity” is a legal term of art, whose specific definition is determined by federal and state statutes.

Generally, criminal defendants found not guilty by reason of insanity did not know or understand, because of mental illness, the nature and quality of their acts or that their acts were wrong. The majority of serial murderers, both in the real world and the Batman universe, would not qualify for a not guilty by reason of insanity defense because they do not have a mental disorder that causes them not to know or understand the nature and quality or the wrongfulness of their acts at the time those acts were committed.

While it is extremely rare for a real-life serial murderer to be found insane (an estimated 4 percent of serial killers attempted to plead insanity as their legal defense; of that group, only 1 percent was actually found to be not guilty by reason of insanity), serial murderers in Gotham City seem almost by default to be (inaccurately) labeled as “insane.”

The Joker has been called both “psychotic” and “insane” but in real life be considered neither.

This may be due, in part, to a misunderstanding of the legal definition of insanity. For example, the Joker, who in numerous depictions has been called both “psychotic” and “insane,” would in real life be considered neither. His psychopathic traits would likely lead him to a prison cell and not a forensic hospital bed.

For individuals who are found legally insane, psychiatric medication is often prescribed to treat the underlying mental disorder. For example, Maxie Zeus might be prescribed medication to treat his psychotic belief that he is a direct descendant of the Greek god Zeus. Other medications or psychotherapies may also be helpful for “non-insane” characters. The Mad Hatter might be prescribed anti-androgen treatment for his pedophilic tendencies, while Harley Quinn might benefit from dialectical behavior therapy. However, medications are not generally prescribed for psychopathic traits; therefore, psychiatric medications would likely not be indicated for the Joker.

And what about the Batman? Well, that’s another story for another time….

The forensic psychiatrists of Broadcast Thought — H. Eric Bender, M.D., Praveen R. Kambam, M.D., and Vasilis K. Pozios, M.D. — will present the panel “Detecting Deviants in the Dark Night: Profiling Gotham City’s Serial Killers” at 7:30 p.m. Thursday during Comic-Con International. Special guest Mark E. Safarik, a retired FBI agent and former profiler with the bureau’s famed Behavioral Analysis Unit will join them for the panel in Room 8 of the San Diego Convention Center.