The Inner Monologue

When Responsibility Becomes a Diagnosis and Crime Becomes a Condition

West Virginia has long been a place where consequences were not theoretical. Mines collapsed. Mills closed. Paychecks stopped. When something went wrong, there was no committee to convene and no glossary to soften the blow. You either fixed the problem, endured it, or left.

Which makes it all the more remarkable that the state has now announced plans for the West Virginia Institute for the Criminally Diseased, a bold new experiment in modern governance that proposes to solve crime not by preventing it, punishing it, or even discouraging it—but by reclassifying it.

The premise is simple and revolutionary: crime is not something people do. It is something they have.

In this framework, the burglar is not a burglar. He is a patient suffering from Compulsive Asset Reallocation Disorder. The meth dealer is not poisoning a community; she is exhibiting symptoms of Entrepreneurial Maladaptation Syndrome. The repeat offender is not ignoring the law—he is experiencing a relapse of Chronic Accountability Resistance.

This is not semantics, we are told. This is science.

For generations, Appalachia lived under a blunt moral architecture. You worked. You pulled your weight. You knew where the lines were. Cross them, and consequences followed—sometimes harshly, sometimes unfairly, but always predictably. That worldview, we are now informed, was outdated, punitive, and insufficiently trauma-informed.

The Institute represents a gentler age. A smarter age. An age where wrongdoing is no longer judged, but diagnosed.

Under the new model, individuals formerly known as criminals will be referred to as “participants.” Courts will be reimagined as intake centers. Sentences will be replaced with “care plans.” And jail—once considered a deterrent—will be reframed as a stigmatizing artifact of an unenlightened past.

Treatment, not punishment, is the slogan. Though treatment should not be confused with correction.

At the West Virginia Institute for the Criminally Diseased, multidisciplinary teams will assess each participant using the DSM-A (Diagnostic and Statistical Manual of Appalachia-Adjacent Malfeasance). These teams will include behavioral specialists, regional equity advisors, systems theorists, and facilitators flown in from states that no longer build things.

Crimes will be translated into conditions. Theft becomes “resource insecurity expression.” Assault becomes “unregulated conflict response.” Vandalism becomes “community dialogue through property.”

Language, after all, is easier to manage than behavior.

Participants will engage in restorative justice circles, where victims are encouraged to share their feelings—provided those feelings do not imply blame or expectation of restitution. Mindfulness training will teach offenders to sit with the idea of accountability without experiencing the stress of enforcement. Workforce programs will explore career readiness in an economy that does not exist yet, but is expected to arrive once attitudes improve.

If participants reoffend, this will not be considered a failure. It will be classified as a “flare-up.” Chronic conditions, officials explain, are not cured—only managed. The goal is not resolution, but continuity of care.

Perhaps the most ambitious aspect of the Institute is its embrace of predictive intervention. Using data models and risk indicators, the state hopes to identify individuals likely to commit crimes in the future and intervene early. This is not surveillance, we are assured. It is preventive compassion.

Residents may take comfort in knowing that the same institutions that could not keep opioid distribution under control now feel confident forecasting moral outcomes.

Supporters argue that this approach is humane and progressive. Critics are typically dismissed as nostalgic, reactionary, or insufficiently credentialed. Many of them, it should be noted, live in communities where police response times are measured in hours and property crime is treated as ambient noise.

The problem with medicalizing crime is not compassion. It is displacement.

Responsibility does not vanish when you rename it. It simply moves—from offender to victim, from individual to community, from the person who commits harm to the people expected to endure it quietly. The Institute does not eliminate punishment; it redistributes it downward.

West Virginia understands systems. It understands what happens when decisions are made far away by people who will never live with the consequences. It understands what it means to be studied, modeled, optimized, and ultimately abandoned by those with better language and worse results.

What the Institute offers is not public safety, but moral anesthesia. It allows policymakers to appear caring without being effective, compassionate without being accountable, and busy without being useful.

Crime becomes an illness. Enforcement becomes cruelty. Skepticism becomes ignorance. And communities are asked—once again—to adapt.

In a state that has buried miners, rebuilt towns, and survived the long collapse of promised industries, the idea that crime is merely a misunderstanding may be the most ambitious fiction yet.

The West Virginia Institute for the Criminally Diseased may well become a national model—not because it works, but because it reflects a growing preference for systems that explain failure rather than prevent it.

It offers empathy without limits, accountability without consequences, and governance without responsibility.

And for a society increasingly uncomfortable with saying “no,” that may be the most accurate diagnosis of all.