When Fixing People Is Mistaken for Care
There is a long history in this country of calling something care when it is, in fact, harm.
And we are still living with the consequences.
In a recent essay by Robert Espinoza, CEO of The CareWorks Project, When Fixing People Is Mistaken for Care, the focus is a recent Supreme Court decision that has reopened a painful and unresolved question: what happens when practices widely understood to be harmful are reframed as protected care?
At the center of the story is conversion therapy—a set of practices that claim to change a person’s sexual orientation or gender identity, despite decades of evidence showing it is ineffective and deeply damaging.
The recent Supreme Court ruling, which struck down a state ban on such practices for minors on free speech grounds, does not endorse conversion therapy. But it raises profound questions about who gets to define care and who is protected when harm is carried out under its name.
A History We Haven’t Fully Reckoned With
The essay situates this moment in a much longer history.
For decades, conversion therapy has been practiced under the authority of institutions—medical, religious, and cultural—that framed difference as something to be corrected. It has been justified as treatment, even as survivors have described lasting psychological harm, including shame, anxiety, and deep questions about self-worth.
This is not an isolated phenomenon. It is part of a broader pattern in American care systems: the impulse to “fix” people rather than support them.
When Care Becomes Harm
What the essay makes clear is that the line between care and harm is not always drawn by evidence alone. It is shaped by law, by culture, and by who holds authority.
Conversion therapy persists not because it works, but because it has been allowed, sometimes even protected, by the systems that govern professional practice.
Major medical and human rights organizations have long rejected it as unsafe and ineffective, linking it to increased risks of depression, anxiety, and suicidality.
And yet, the recent ruling underscores a difficult reality: even when harm is well-documented, the systems meant to regulate care do not always align with that evidence.
Why This Matters for Leaders
For leaders across healthcare, workforce development, philanthropy, and public policy, this moment extends beyond any single issue.
It raises a deeper question: Who gets to define what care is? And just as importantly: What happens when systems protect practices that cause harm? This is not just about conversion therapy. It is about the broader architecture of care in this country.
We see similar tensions across systems:
When workers are asked to provide care without the support they need
When families are left to fill gaps that systems fail to address
When policies reinforce outdated assumptions about who deserves care—and how it should be delivered
In each case, the definition of care is shaped not only by need, but by power.
If we are not willing to interrogate those definitions, we risk reproducing harm—even when we believe we are helping.
What The CareWorks Project Is Doing About It
At The CareWorks Project, we believe that care must be defined by dignity, evidence, and lived experience—not by outdated assumptions or institutional inertia.
Our work is grounded in a simple but urgent idea: care should not harm the people it is meant to support.
We partner with leaders across sectors to:
Redesign care systems so they reflect the realities of people’s lives
Align policy and practice with what we know actually improves outcomes
Elevate the voices of those most impacted by care systems
Challenge narratives that equate control, correction, or conformity with care
This is about more than reform. It is about redefining care itself—so that it supports people as they are, not as systems expect them to be.
Because the future of care will depend not just on what we build, but on what we are willing to question.
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