Content note: this essay discusses psychosis, psychiatric diagnosis, burnout, and the institutional treatment of Mad people. It does not describe self-harm or crisis in detail. Support links are at the end. Pronunciation: sim-FREE-nee-a.
In brief
Schizophrenia means split mind. We are proposing a different word, symphrenia, meaning connected bodymind, for a way of experiencing the world in which connections are felt with unusual depth and intensity, sometimes more than a person can hold.
We found it where AuDHD and psychotic experience meet, because that is where we live. One of us is Schizophrenic and one of us is Bipolar and also on the Schiz0phrenic spectrum, which turns out to be part of the point.
Symphrenic is an identity people can choose for themselves. Nobody can diagnose it, assign it, or take it away. We are not arguing against medication, clinical care or anyone’s chosen support. We are asking who gets to decide which connections count as real, and we are inviting the people who live this to help shape the word.
A few words used here. Phrēn: ancient Greek for the breathing chest, where thought and feeling were believed to live. Liminal: on a threshold, between one state and the next. Monotropism: a theory of attention that pools into fewer channels and runs deep in them. Apophenia: a clinical term for seeing connections that appear, to an observer, to have come from nowhere. Hermeneutical injustice: being unable to make sense of your own experience because the language for it does not exist yet.
Why a new word?
In 1908, the Swiss psychiatrist Eugen Bleuler was looking for a way to describe a group of experiences he saw in his patients, where thinking, feeling and acting seemed to come apart from one another and stop working together in the usual way. The existing label, Emil Kraepelin’s “dementia praecox”, meant “early dementia” and carried an assumption that people would steadily and inevitably decline. Bleuler had seen that this wasn’t always true, so he built a new word from Greek: schizo, meaning to split, and phrēn, meaning mind (Bleuler, 1911/1950).
His intention was, in his own terms, hopeful. He meant a loosening between thinking, feeling and willing, and he did not consider the outcome fixed (Moskowitz & Heim, 2011). The word travelled further than the intention. In public imagination, in clinical habit, and in a great deal of private fear, it came to mean a shattered mind, and more than a century of psychiatry, funding and policy has taken shape inside that picture.
A name like that works less as a description than as a proposal. It suggests that something whole has come apart, and that the task is to find the fracture. Wards, assessment tools, drug trials, and the first bewildering evening a family spends trying to understand someone they love have all been oriented, in their different ways, towards looking for a break.
Symphrenia draws on syn or sym, with or together, and the same phrēn Bleuler used. In Homeric Greek, phrēn had little to do with a disembodied intellect. It sat in the breathing chest, where the Greeks understood thought, feeling and breath to be held together (Onians, 1951; Sullivan, 1988). It was a bodymind word long before anyone needed the term bodymind (Price, 2015; Clare, 2017). If phrēn is the diaphragm, it also names a threshold: a membrane between chest and belly, belonging fully to neither, rising and falling with every breath.
We want to explain why we reached for phrēn rather than neuro. Some Mad Studies writers are wary of the “neuro” in neurodiversity, because it seems to place everything inside the brain. A phrēn word does not. It puts the experience back in the whole breathing body, which is where we find it.
Where schizophrenia speaks of a mind that has split, symphrenia speaks of a bodymind that lives in the threshold, connected across it.
What do we mean by it?
Three related words, because one cannot hold all of it.
• Symphrenia is the experience of the connected bodymind. The felt sense of thinking and feeling alongside the collective world, in porous kinship with the unperceived, people, creatures, places and things, living and non-living.
• Symphrenic is an identity, for people who perceive connections that others around them do not perceive. Such perceptions are usually described as delusions or hallucinations.
• Symphrenic cognition is what that perception can become when it is worked with rather than suppressed.
We want to be careful about the difference between those first two, because an earlier draft of this essay was not.
The identity is entirely self-defined. It is a name a person may choose for themselves, if they resonate with this word. There is no assessment behind it and no criteria to meet.
Whether there is also a shared way of attending underneath it, something that could one day be described and perhaps even studied, is a question we are putting to the community rather than a finding we are announcing. We think there may be. We would rather be wrong about that in public than quietly turn a self-chosen name into a category that someone else can apply to you. A name you choose is a different kind of thing from a label you are given, and we would like to keep the two apart.
Two of us, two diagnoses, one word
Here is something that took us a while to notice.
David is Autistic, ADHD and Schizophrenic. Helen is Autistic, ADHD and Bipolar and on the Schizophrenic spectrum, and has had experiences of psychosis. We sit in two differing yet similar diagnostic categories. We recognised the same thing in each other anyway. We met through David’s work on monotropism, burnout, and psychosis, and neurokinship formed through shared experience.
That is not a charming coincidence. It is information about the categories. The boundary between schizophrenia and bipolar disorder has been eroding in clinical and genetic research for years, to the point where the division is routinely described as going rather than gone (Craddock & Owen, 2010), and large genetic studies have found propensity shared across autism, ADHD, bipolar disorder, major depression and schizophrenia rather than neatly partitioned between them (Cross-Disorder Group of the Psychiatric Genomics Consortium, 2013). Schizoaffective disorder exists as a category largely because the line would not hold. In truth, what is described as discrete diagnostic categories is in fact a tangled rhizome of experiences that humans attempt to contain within those discrete categories.
It also matters that connection does not feel the same in every state. The overflow of psychosis and the accelerating, expansive connection of mania are not identical experiences, and a word that flattened them would not be much use to anyone. What they appear to share is the direction of travel: more connection arriving than there is room for.
So symphrenia is not a label sitting underneath other labels. We found it at the meeting point of AuDHD and psychosis because that is where we live, and we are deliberately not drawing a fence around who may use it. Schizophrenic people who are not Autistic, voice hearers, people whose spiritual or religious lives involve connections others cannot see, and people we have not thought of may recognise themselves here, or may not. Deciding in advance who qualifies would repeat exactly the gatekeeping the word is meant to set down.
Has the neurodiversity movement left madness out?
Not originally, and this is worth getting right.
Kassiane Asasumasu, who coined “neurodivergent”, meant it to include mental illness and madness from the start. What has happened since is drift in how the movement took the word up. In everyday use, “neurodivergent” has slid towards meaning something like “thinking differently in a way others can still follow”, and psychosis is perhaps the experience most likely to fall outside that. There is something quietly painful in noticing where the pride tends to stop, in seeing which experiences meet the affirming infographic and which meet a careful referral.
That makes our ask smaller than it first appears. We are not requesting that the paradigm be extended to somewhere new. We are pointing out that it was built wide enough already, and asking why the welcome narrowed.
Meanwhile Mad Studies, survivor scholarship and the Hearing Voices movement have been developing the structural argument for considerably longer, with far less institutional protection and funding (LeFrançois et al., 2013; Romme & Escher, 1989), largely in what has felt like a separate room. Doorways exist: Nick Walker (2021) and Melanie Yergeau (2018) on neuroqueerness, Robert Chapman (2023) on how capitalism produces and polices “normal” minds. Writing from Mexico, Guzmán Martínez and colleagues (2026) argue for Mad, crip and neurodivergent alliances that reach past identity towards dignity for lives marked as abnormal, which is close to what we are reaching for here.
Seeing what others miss, and seeing what is not there
In 1958, Klaus Conrad introduced the term apophenia, usually rendered as the “unmotivated seeing of connections”, accompanied by a sense of abnormal meaningfulness (Conrad, 1958; see Mishara, 2010). It still underlies a great deal of how psychosis is assessed.
Notice which word carries the weight. Conrad did not call the connections false. He called them unmotivated.
We are reading him against the grain here, and we want to say so rather than have it pointed out. In Conrad’s own phenomenology, “unmotivated” describes something about the experience itself: meaning arrives unbidden, without the person being able to say where it came from. That is a real description and many people recognise it. What we are doing is turning the word outward as well as inward, and asking what happens when the judgement is made by someone else.
Because a connection also looks unmotivated when the person judging it cannot see what gave rise to it. That tells us about the observer’s access to someone’s reasoning, not about the reasoning. The clinician has often not been told, and frequently could not be told in the time available, how the person got to where they got. The route is recorded as absent, and its absence recorded as pathology.
There are really three things being sorted here, not two:
• Perceiving something others have overlooked. It is there; they missed it.
• Perceiving something others cannot perceive. It is there, in some sense, and not available to them.
• Perceiving something that is not there.
Our argument is narrow and we want to keep it that way. It is not that the third category is empty. Some connections are simply not there, psychosis can be terrifying, it can take years from a life and it can take a life. Our argument is that the apparatus doing the sorting cannot reliably tell the three apart, because what it actually measures is whether a pattern makes sense to whoever holds the power to name it. Accuracy and legibility are different qualities, and the apparatus is far better tuned to the second.
Some things sit alongside this easily. Information passed between Autistic people holds up as well as it does between non-Autistic people, and better than across the two groups (Crompton et al., 2020): when the listener shares your frame, your connections stop looking unmotivated. The connections did not change; the audience did. Object personification, relating to objects as though they have inner lives, is more common among Autistic people and is for many of us ordinary and tender (White & Remington, 2019), yet described in another room by another person it becomes a textbook symptom. Nothing inside the experience decides which room you are in. And voice-hearing itself takes different shapes in different places: Luhrmann and colleagues (2015) found that people with psychosis in the USA, India and Ghana described their voices in markedly different terms, with harsher and more intrusive experiences more common in the American sample.
The philosopher Miranda Fricker (2007) gives this a name. Testimonial injustice is when someone’s account is believed less because of who they are. Hermeneutical injustice is when a person lacks the shared concepts needed to make their own experience intelligible, to others and sometimes to themselves. The missing word is a hermeneutical gap of exactly that kind. Symphrenia is an attempt to close it from the inside.
We should be fair to psychiatry here. Contemporary clinical accounts already describe psychosis as a flood of meaning rather than an absence of it (Kapur, 2003). At the level of description we are closer than the opening of this essay suggests. The disagreement is about what happens next, and about who holds the authority to decide.
An identity, freely claimed
Symphrenic can only be claimed by the person themselves. No clinician can apply it. No researcher can code a participant as symphrenic. No author, ourselves included, can look at someone and decide this is what they are. There is no assessment, no threshold, no gatekeeper and no waiting list.
This sits at the centre, for three reasons.
Diagnosis is distributed unevenly, along lines that bear little relation to experience. In England in 2024–25, people in the “Black or Black British” group were detained under the Mental Health Act at 262.4 per 100,000, nearly four times the rate for the White group at 65.8, a ratio of 3.8 and up from 3.4 the previous year. Detention rates also rose with deprivation, with the most deprived areas more than three and a half times the least deprived (NHS England Digital, 2025). Jonathan Metzl (2009) traced how, in the United States during the civil rights era, schizophrenia was reshaped in clinical writing into a diagnosis disproportionately given to Black men, with protest itself sometimes read as symptom. Any term that must pass through the diagnostic system inherits that history.
AuDHD people are misread by that system in two directions at once. Monotropic absorption can be read as thought disorder, sensory experience as hallucination, alexithymia as flat affect. Meanwhile genuine psychotic experience gets set aside as “part of the autism” and left unsupported for years.
And the people this word may most be for are often the ones the system turned away: the undiagnosed, the misdiagnosed, and those who looked at the assessment pathway, considered what a label might cost them at work, in family court or at a border, and chose not to pursue it.
Thresholds are not equally safe for everyone, and we would rather say so than offer a romance of liminality to people who can afford it while others pay its costs. A Black Autistic person who hears voices, a trans person in psychiatric crisis, a working-class Mad woman, a migrant whose distress is read through a language they do not share: each meets this system at more than one edge at once, and each edge sharpens the others (Crenshaw, 1989).
What changes if we see it this way?
The question moves from what is wrong with this person towards what is wrong with the world around them. The second question is harder, because it shifts responsibility onto services, schools, workplaces, families and policy, which may be why it is asked so rarely. This is the move at the centre of the ecosystemic model of distress, which David developed with Tanya Adkin: distress is information about an environment rather than a symptom of a person.
It is not only a philosophical preference. A meta-analysis of 36 studies found childhood adversity associated with psychosis at an odds ratio of 2.78, with around a third of psychosis cases in the population attributable to adversity exposure (Varese et al., 2012). Roughly a third. The environment is not background here; it is a substantial part of the cause, and that finding comes from inside the research establishment rather than from us. The Power Threat Meaning Framework (Johnstone & Boyle, 2018) builds a whole alternative to diagnosis on the same ground, reading distress as a meaningful response to threat rather than as a symptom list.
Four things follow.
Prevention becomes possible, and it is ordinary. If burnout often precedes psychosis for Autistic people, then rest, sensory safety, reduced demand and protected time for restoring interests are forms of prevention, offered before crisis rather than after it.
Joy becomes a measure. We have become reasonably good at arguing that distress is environmental. We say almost nothing about the fact that joy is environmental too, and that a great deal of intervention has been organised around removing it: play recorded as stereotypy, stimming extinguished as a behaviour target, interests rationed as a reward. A system that only measures reduction cannot tell a flourishing person from a subdued one, because subduing reduces things.
Substance use stops looking like a separate problem. People in unbearable states reach for what is available. Taking away someone’s only working solution without putting anything in its place is not treatment, and the ecosystemic reading makes that obvious in a way the individual one does not.
Restriction becomes visible as harm. Autistic people in psychiatric crisis are at elevated risk of restraint, seclusion and detention, and many experience admission as adding to the trauma that set the cycle going. If distress is information about an environment, responding to it by further restricting the person is not only cruel, it is a category error.
For practitioners, the smallest useful version of all this is one question: ask what route the person took to this connection, and treat the route as meaningful rather than recording it as missing.
A word still being made
Symphrenia is a proposal and an offering, some distance from a settled framework. A word that touches the experience of psychosis cannot be decided by two people, however deeply either of us lives in it. Until a wider community has shaped it, we offer it provisionally.
We are not the first to try this. The Hearing Voices movement has spent nearly forty years doing something closely related, and doing it well: a reframing of an experience, generated by the people having it, which changed what was possible for a great many people (Romme & Escher, 1989). We have learned from that example and want to say so. Where we differ is scope. They began with a specific experience, voice hearing, and built outward. We are starting from an attentional and relational style that runs through AuDHD life and reaches, at its most intense, into psychosis. We may be wrong to start there, and the Hearing Voices precedent suggests it is the people living the experience who should decide.
Nor are we the first to notice thresholds. Michael Thalbourne’s concept of transliminality, developed for psychosis and spirituality by Isabel Clarke, describes a heightened permeability across the threshold between conscious, unconscious and outer world (Thalbourne & Maltby, 2008; Clarke, 2010). That is close enough to our reading of phrēn that we should say what we think symphrenia adds: kinship rather than permeability alone, an identity people can claim, and a political argument about who holds the authority to name an experience.
So this is an invitation.
If you are AuDHD and have perceived connections others could not see, if your route has been recorded as absent and that absence recorded as illness, if the language of a shattered mind has never quite matched the experience of a bodymind that will not stop connecting, we would be glad to hear from you. The same applies if you come to this from somewhere else entirely and something here speaks to you. Tell us where the word goes wrong, what it misses, what it flattens, what it might make harder. If you would prefer nothing to do with it, that is useful too.
We are not asking anyone to adopt it. We are asking whether it is worth building with care and, if so, who might want to build it with us.
Bleuler named this without asking the people he named. We would rather name it with them.
If you need support
You do not need to be in crisis to reach out. The Hearing Voices Network (hearing-voices.org) runs peer support groups for people who hear voices, see visions or have other unusual perceptions, and Intervoice (intervoiceonline.org) connects voice-hearing networks internationally. Mind (mind.org.uk) offers information and local services in England and Wales. Samaritans can be reached free, day or night, on 116 123 in the UK and Ireland.
Symphrenia was conceptualised jointly by David Gray-Hammond and Helen Edgar. Existential diversity is the product of the same shared work (Gray-Hammond & Edgar, forthcoming). The ecosystemic model of distress was developed by David with Tanya Adkin, and the burnout-psychosis cycle draws on Tanya Adkin’s concept of the monotropic spiral.
The longer version of this argument, with the full scholarship behind it, is in the companion essay. A plain-language version is also available.
References
Chapman, R. (2023). Empire of normality: Neurodiversity and capitalism. Pluto Press.
Clare, E. (2017). Brilliant imperfection: Grappling with cure. Duke University Press.
Clarke, I. (Ed.). (2010). Psychosis and spirituality: Consolidating the new paradigm (2nd ed.). Wiley-Blackwell.
Conrad, K. (1958). Die beginnende Schizophrenie. Thieme.
Craddock, N., & Owen, M. J. (2010). The Kraepelinian dichotomy: going, going… but still not gone. British Journal of Psychiatry, 196(2), 92–95.
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex. University of Chicago Legal Forum, 1989(1), 139–167.
Crompton, C. J., Ropar, D., Evans-Williams, C. V. M., Flynn, E. G., & Fletcher-Watson, S. (2020). Autistic peer-to-peer information transfer is highly effective. Autism, 24(7), 1704–1712.
Cross-Disorder Group of the Psychiatric Genomics Consortium. (2013). Identification of risk loci with shared effects on five major psychiatric disorders. The Lancet, 381(9875), 1371–1379.
Fricker, M. (2007). Epistemic injustice: Power and the ethics of knowing. Oxford University Press.
Guzmán Martínez, G., Vargas García, B., & Alps, A. (2026). Mad-crip-neurodivergent alliances beyond identity: Reflections from the Global South. Teknokultura, 23(2), 175–185.
Johnstone, L., & Boyle, M. (2018). The Power Threat Meaning Framework. British Psychological Society.
Kapur, S. (2003). Psychosis as a state of aberrant salience. American Journal of Psychiatry, 160(1), 13–23.
LeFrançois, B. A., Menzies, R., & Reaume, G. (Eds.). (2013). Mad matters: A critical reader in Canadian Mad Studies. Canadian Scholars’ Press.
Luhrmann, T. M., Padmavati, R., Tharoor, H., & Osei, A. (2015). Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana. British Journal of Psychiatry, 206(1), 41–44.
Metzl, J. M. (2009). The protest psychosis: How schizophrenia became a Black disease. Beacon Press.
Mishara, A. L. (2010). Klaus Conrad (1905–1961): delusional mood, psychosis, and beginning schizophrenia. Schizophrenia Bulletin, 36(1), 9–13.
Moskowitz, A., & Heim, G. (2011). Eugen Bleuler’s Dementia praecox or the group of schizophrenias (1911): a centenary appreciation and reconsideration. Schizophrenia Bulletin, 37(3), 471–479.
NHS England Digital. (2025). Mental Health Act statistics, annual figures, 2024–25.
Onians, R. B. (1951). The origins of European thought. Cambridge University Press.
Price, M. (2015). The bodymind problem and the possibilities of pain. Hypatia, 30(1), 268–284.
Romme, M., & Escher, S. (1989). Hearing voices. Schizophrenia Bulletin, 15(2), 209–216.
Sullivan, S. D. (1988). Psychological activity in Homer: A study of phrēn. Carleton University Press.
Thalbourne, M. A., & Maltby, J. (2008). Transliminality, thin boundaries, unusual experiences, and temporal lobe lability. Personality and Individual Differences, 44(7), 1617–1623.
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., van Os, J., & Bentall, R. P. (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective and cross-sectional cohort studies. Schizophrenia Bulletin, 38(4), 661–671.
Walker, N. (2021). Neuroqueer heresies. Autonomous Press.
White, R. C., & Remington, A. (2019). Object personification in autism. Autism, 23(4), 1042–1045.
Yergeau, M. (2018). Authoring autism: On rhetoric and neurological queerness. Duke University Press.
delighted to co-author this with you!