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Gatekeeping Gender: Hypothetical Questions in Interactions Between Psychiatrists and Transsexual Patients
Unformatted Document Text:  24 have is grounded arguments about psychiatric practice based in action, not speculation. More specifically, we have shown how psychiatrists’ and patients’ views about what psychiatry is in this context, get played out interactionally and oriented to by both parties to the interaction. In other words, the interaction reflects, constitutes and reconstritutes this as a certain kind of institution or social structure. The precise function of hypothetical questions is highly dependent on the interactional environment in which they occur. In contexts where the doctor is a gatekeeper, hypothetical questions work rather differently than they have been shown to do in the more therapeutic environments discussed by Perakyla, where the counsellor has no control over whether the proposed hypothetical scenario may come about (for example, the counselors in Perakyla’s data cannot influence whether the client will die of an AIDS-related illness). In our data, by contrast, the psychiatrist does have the institutional authority to influence whether the proposed hypothetical scenario may come about. Since patients are attuned to this, it follows that they are never free to talk in an ‘uncensored’ fashion, but must continuously monitor themselves for displays of authenticity and of their genuine commitment to their aspired-for gender role. So to what extent can the psychiatrists’ interactional strategies be considered successful? And what are the implications of this analysis for the psychiatric assessment and treatment of transsexual patients, and psychiatry more broadly?

Authors: Speer, Susan. and Parsons, Ceri.
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24
have is grounded arguments about psychiatric practice based in action, not
speculation.
More specifically, we have shown how psychiatrists’ and patients’ views about what
psychiatry is in this context, get played out interactionally and oriented to by both
parties to the interaction. In other words, the interaction reflects, constitutes and
reconstritutes this as a certain kind of institution or social structure.
The precise function of hypothetical questions is highly dependent on the interactional
environment in which they occur. In contexts where the doctor is a gatekeeper,
hypothetical questions work rather differently than they have been shown to do in the
more therapeutic environments discussed by Perakyla, where the counsellor has no
control over whether the proposed hypothetical scenario may come about (for
example, the counselors in Perakyla’s data cannot influence whether the client will die
of an AIDS-related illness).
In our data, by contrast, the psychiatrist does have the institutional authority to
influence whether the proposed hypothetical scenario may come about. Since patients
are attuned to this, it follows that they are never free to talk in an ‘uncensored’
fashion, but must continuously monitor themselves for displays of authenticity and of
their genuine commitment to their aspired-for gender role.
So to what extent can the psychiatrists’ interactional strategies be considered
successful? And what are the implications of this analysis for the psychiatric
assessment and treatment of transsexual patients, and psychiatry more broadly?


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