John Cusack is fictional, as are the others. Malcolm Rivers (The "host") suffers from multiple personality disorders and the characters in the motel were actually personalities. All of them have distinguishing characteristics which lead to the fact that they are just Malcolm's creations (eg. Same birth date, surnames are all also names of towns). In the end, the only person to leave the motel alive is Paris (Amanda Peet) as Ed (Cusack) and Rhodes (Liotta) shot each other to death. On their way to a mental institution, Malcolm has another vision, he sees Paris doing some gardening when Timmy (the little boy) appears with a door key with the number 'one' on it. We then realise he is the murderer as he was behind everyone's death in some way. Not only does Timmy kill Paris, but the personality takes control of Malcolm, who then strangles the doctor who is sitting in the seat in front of him. The car stops in the middle of nowhere.
Trivia: The scene directly before the first victim, "the movie star", is killed she is talking to herself in the mirror. You can see her reflection and the reflection of the window behind her. If you pay close attention you can see that there is a silhouette in the curtains. Eventually the lightning flashes and you can see the face of the little boy in the silhouette looking into the window at her.
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