Anton and Mike are not insane

Joker and Carnage lives and breathe in this trope.

@RadTheShadow VII I think chigurh is insane, because it looks like he is psychotic and he thinks he is something more than human and some kind of force who must decide about fates of humans lives, even If he is just normal human who is psychopath. He kills humans without any good reason, just because he thinks he have to do so. I think that is really insane, even if he is smart too

Excluding the ones on the list, I think these four deserve at least an honorable mention:

• Brian Irons: His mask of sanity is completely destroyed when Raccoon City goes to hell, starting a killing spree for the evulz under the mere paranoia that he became infected. Even before the outbreak he was quite reckless and unstable, raping someone in what looks like a public classroom, and even pointing a gun at someone over a joke.

• Judge Claude Frollo: I'm sorry but how was he under "Psychopaths" for so long? It's implied twice that he suffers hallucinations (during the Hellfire song and the snarling gargoyle in the climax), and he becomes increasingly homicidal and sadistic after meeting Esmeralda. Not to mention he's extremely delusional to the point of a god complex.

• Corporal Gallo: Apart from being dissociative, he also plays sadistic games with the only 60,000 survivors of Earth's destruction just to feed his raging god complex.

• Quentin McNeil: An abusive serial killer and rapist in the making, prone to temper tantrums and hallucinations (he thinks he has x-ray vision and that Kazan and Worth are spies). He was by the far the only who deserved being put in the cube.

Patrick appears to suffer from several mental illnesses including psychosis and derealization, ending up seeing surreal hallucinations such as a Cheerio sat upon a tiny chair and interviewed on The Patty Winters Show, a walking park bench following him for several blocks, an ATM telling him to kill the president, etc. Anton’s psychopathy possibly outweighs his insanity (the latter of which, as far as we know, being limited to a single delusion that drives his actions—a delusion that he is forcibly snapped out of at the end), whereas Patrick maintains a (un)healthy balance of both that we get disturbing glimpses into.

Haven’t read any of the comics so correct me if I’m wrong, but I don’t think the Joker’s “insanity” was ever delved into as much other than him laughing a lot and acting goofy. He doesn’t seem that out of touch with reality since he can rationalize his actions with nihilism; he seems to kill people because “Fuck you, I’m crazy / nothing matters”