Gatekeeping gender: some features of the use of hypothetical questions in the psychiatric assessment...

<jats:p>Psychiatrists, like other medical professionals with a diagnosing or prescribing role, control access to a range of forms of treatment, medication and service that their patient, or their patient’s carer, may want access to. In this article, we explore psychiatrist-patient interactions in the distinctive institutional site of a UK NHS Gender Identity Clinic, where the psychiatrist’s gatekeeping role is renowned. We focus on some interactional features of the psychiatrist’s gatekeeping role as it gets played out and oriented to in a specific class of question that they ask their patients. This class of questions involves the psychiatrist putting to the patient a possible future hypothetical scenario where the patient’s treatment is withdrawn. We show how these hypothetical questions function in the psychiatric assessment of transsexuals, and how the psychiatrist’s institutional, gatekeeping role is made manifest both in the design of the hypothetical question and in the response that is elicited from the patient. We end by considering the extent to which hypothetical questions may be deemed a ‘useful’ or a ‘successful’ strategy in the psychiatric assessment of transsexual patients.</jats:p>