(((((((Phoenix)))))))

I see what you're doing in that situation not as facing your fears, exactly, but more as trying to overlook them so that you can continue to do what you see as your duty. You may even (I'm guessing here) find yourself trapped between fear of getting attacked and fear of failing to do your job. I don't claim to know much about PTSD but that sounds to me like a recipe for it.

I see the job situation you're currently in as highly unnatural, for want of a better term. In what I'm calling a natural situation it would be just you and the patient and you'd both be free to relate, as the spirit might move you, in any way that suited you including having nothing to do with each other. You might, for instance, ask the patient from a comfortable distance whether he'd like some company that day or not; he'd be free to accept or decline; and if he turned out to be in a foul mood and came after you, you'd be free to get away and stay away. Among other things, that arrangement might in time get it through to the patient that he had nothing to fear from you and no need to attack you.

In your current situation, you're there not as yourself but as the nearest available representative of the system that's keeping that patient confined and frustrated. He can probably figure out on some level that you're there not because you enjoy being with him but because you're carrying out orders. If he wants to send the system some message such as "Let me out of here, you *******s," he doesn't expect to be taken seriously so he's taking out his frustration on the physical plant and on any staff impudent enough to get within reach.

It might be a little different if the system really worked, if when he got aggressive he'd consistently find himself surrounded by enough well-trained people to protect him from himself and settle him down. When it's just you, though, you're in effect communicating to him that although the system is badly broken and you're there unsupported, you'd like him to play along and pretend there are four or five of you and everything's working as it should. He's pointing out to you in the bluntest way that he doesn't want to play along and questioning equally bluntly why you'd want to, either. You now seem to be searching for a satisfactory answer to that.

I hope you'll either prove me wrong or get yourself out of there before the patient proves me right.