Document ID: ./input/supremecourt_opinions/opinions/19pdf/17-1618_hfci.pdf
Page Number: 72

Cite as:  590 U. S. ____ (2020) 

35 

ALITO, J., dissenting 

selection of modifiers, referents, or grammatical forms”). 

While it is likely true that there have always been indi-
viduals  who  experience  what  is  now  termed  “gender  dys-
phoria,” i.e., “[d]iscomfort or distress related to an incongru-
ence  between  an  individual’s  gender  identity  and  the 
gender  assigned  at  birth,”31  the  current  understanding  of
the concept postdates the enactment of Title VII.  Nothing
resembling what is now called gender dysphoria appeared 
in either DSM–I (1952) or DSM–II (1968).  It was not until 
1980 that the APA, in DSM–III, recognized two main psy-
chiatric diagnoses related to this condition, “Gender Iden-
tity Disorder of Childhood” and “Transsexualism” in adoles-
cents and adults.32  DSM–III, at 261–266. 

The first widely publicized sex reassignment surgeries in 
the United States were not performed until 1966,33 and the 
great majority of physicians surveyed in 1969 thought that
an individual who sought sex reassignment surgery was ei-
ther “ ‘severely neurotic’ ” or “ ‘psychotic.’ ”34 

It defies belief to suggest that the public meaning of dis-
crimination because of sex in 1964 encompassed discrimi-
nation  on  the  basis  of  a  concept  that  was  essentially  un-
known to the public at that time. 

D 
1 
The Court’s main excuse for entirely ignoring the social
context in which Title VII was enacted is that the meaning
of Title VII’s prohibition of discrimination because of sex is 

—————— 

31 American  Psychological  Association,  49  Monitor  on  Psychology,  at 

32. 

32 See Drescher, supra, at 112. 
33 Buckley,  A  Changing  of  Sex  by  Surgery  Begun  at  Johns  Hopkins, 
N. Y. Times, Nov. 21, 1966, p. 1, col. 8; see also J. Meyerowitz, How Sex
Changed 218–220 (2002). 

34 Drescher, supra, at 112 (quoting Green, Attitudes Toward Transsex-
ualism  and  Sex-Reassignment  Procedures,  in  Transsexualism  and  Sex 
Reassignment 241–242 (R. Green & J. Money eds. 1969)).