That Girl

Being that the thugs around the asylum are going around kidnapping doctors and/or looking to kill you it wouldn't make all that much sense to leave them be. There is one area with enemies that you don't have to fight them, but you should because it's both funny and will give you an achievement/trophy. Also, those inmates are labeled 'lunatics' because they run around being crazy and will attack you. It's not like you're going around punching innocent people for no reason. I'm a huge Batman fan so I think this game is amazing.