The character was created by writer Gen Urobuchi, who intended to make him look alienated from his society with influences from Heath Ledger's incarnation of the villain Joker from The Dark Knight (2008).

Critical reception of the character has been largely positive, with his role as a strong villain due to the impact of his actions on protagonists Akane Tsunemori and Shinya Kogami.

[3] Writer Gen Urobuchi said one of the series' central themes is "fear"; Makishima feels out of place, but could have found happiness if he had been born into a normal world.

[4] Director Naoyoshi Shiotani regarded Heath Ledger's incarnation of the villain Joker from The Dark Knight (2008) as a major inspiration for Makishima; both characters are seen as criminals but the audience at the same time does not consider their way of thinking wrong.

Their first names are also opposite; shōgo (正午) is the portion of the day from midday and sunset, and shin'ya (深夜) is the time from midnight to sunrise.

[9] Makishima is the antagonist of the first Psycho-Pass series where he wishes to take down the Sybil System which forces mankind to take their own destined lives rather than an option of free will.

He claims that this is because his mind (and body) does not consider his murders and other crimes "wrong", but "sound"; this in turn makes him immune to the Dominator weapon worn by Inspector Akane Tsunemori.

[11] Makishima tries to destroy the Sybil System by distracting the Bureau forces with chaos in the streets, but is arrested by Tsunemori after a fight with Kogami.

Although his orchestration of several crimes was praised, Kotaku's Richard Einsbeis criticized his deus ex machina-like tactic to prevent himself to be shot by the system's weaponry in his debut when Tsunemori as the advanced gun only attacks criminals and Makishima is the exception.

[20] Thomas Zoth of Fandom Post among other reviewers praised the impact Makishima makes on Tsunemori after killing one of her best friends in a merciless scene.

[21][22][23] Jacob Chapman of Anime News Network (ANN) said Makishima's values are important to the audience as they find them acceptable despite his cruel methods.

"[25] His fights against Shinya Kogami were also the subject of praise;[26] Bamboo Dong of ANN appreciated the series' use of weaponry, but criticized Urobuchi's attempt to make the two rivals similar psychologically.

[30] ANN writer Gabriella Ekens analyzed Makishima's tendency to cite literary works, most notably 1984 by George Orwell set in a dystopia similar to Psycho-Pass.