We’ve both done the same things:

• evaluated patients intoxicated with or withdrawing from alcohol, cocaine, heroin, and methamphetamine
• managed belligerent patients who were psychotic (please note that this does not mean that all patients who are psychotic are belligerent)
• refused to prescribe medications to patients
• managed patients who became angry and frustrated because they did not receive Xanax, Vicodin, or Adderall from us
• refused to admit patients into the hospital
• managed patients who became livid upon learning that we would not provide them with a bed for the night

He, however, has been nearly physically assaulted, threatened with bodily harm, and warned to watch over the safety of his family. From what I can tell, angry, male patients also expend much more energy yelling at him than at me.

And this is not a testament to his lack of clinical acumen as a psychiatrist: He is skilled. His peers and superiors uniformly hold high regard for him; “his” patients (versus patients we see in the emergency rooms or in consultation) compliment him and appreciate his work; he’s a genuinely nice guy. Fellow residents have described him as a “sweet Boy Scout”.

He’s also physically intimidating. He could be a football player—a defensive lineman. Or a bouncer for an exclusive club. Or a Secret Service Agent.

And I believe the sole reason why he receives so much more negative energy than I do in our clinical work is because he is a large, stocky man.

This totally sucks for him because it makes the job significantly more stressful. No one likes or wants immersion in the churning waters of anger; we all run from the tides of conflict when given the opportunity.

I’m not sure if angry men do not threaten me because I am a woman or they threaten him because he is a man. When men become angry with me, do they refrain from threatening me because of something like chivalry? (Perhaps, though I am not inclined to believe so—a man did once threaten to bite into his gaping arm wound and spit blood at me if I got any closer to him; that’s not chivalrous.) Is it because they can already sense my fear? (Which, admittedly, I readily advertise and use to further secure my personal safety.) Is it because, on some level, they realize that although I may be freaked out, I still expect them to behave appropriately? Is it because they know they can injure me, but I am simply not worth the effort?

When confronted with my large male peer, do angry male patients succumb entirely to testosterone and prepare to fight? Is there a greater thrill in assaulting my colleague, The Man, than in taking down me, who clearly does not resemble The Man (or The Woman or any other traditional authority)? Do they sense my peer’s simmering anger and frustration and build upon that energy? Is it merely a cultural effect—you know, it’s okay to get into a fight with a large man, but not with a woman?

I make a point of avoiding the term “angry patient” and focus particularly on “angry men” because angry, psychotic women specifically have the same risk of engaging in violent behavior as angry, psychotic men (which is higher than non-psychotic men and women). (I do not have a citation for this right now.) Several angry, psychotic women have threatened to pummel me. I do not take their threats lightly.

Regardless of how we proceed in our lives, we bring so much more than just our personalities to our interactions with others. (Stating the obvious is part of my charm.) My good friend, though gentle and delightfully diplomatic, can’t “turn off” his male brawn. I wonder not only how he feels when these episodes unfold, but also how much frustration he feels afterwards when he reviews the situation to learn how he can minimize conflict in the future. His physical appearance may unfortunately serve as a biological cue that activates other men to actions they would never consider if they interacted with me.

And what assumptions do I trigger in patients during our interactions? I absolutely modulate both my appearance and behaviors to maximize rapport with and engage patients—but what about those things I can’t control? Would patients react to me differently if I were shorter? what if I wore skirts, showed some leg? what if I had blonde hair, blue eyes, and freckles? Could I possibly be a “better” psychiatrist? (Whatever “better” means?) a better dancer? a better writer? a better blogger? a better human being?