Maternal adjustment disorder (MAD)

This is not a real disorder, but it should be.

Adjustment disorder is a real disorder (included in World Health Organisation mental health classifications) and I have just bunged “maternal” in front of it to describe how I and many other mums I know felt when we became mums.

The legitimate diagnosis of adjustment disorder is described as a “state of subjective distress and emotional disturbance, usually interfering with social function and performance, and arising in the period of adaptation to a significant life change or to the consequences of a stressful life event. The stressor may have affected the integrity of an individual’s social network or the wider system of social supports and values” (ICD-10).  It’s supposed to apply to stressors like migration, bereavement or adaptation to illness or disability; but why not modern-day motherhood?

Having a child is a significant life change. What I found distressing was not the obvious sleepless nights, financial pressures, breast feeding, fevers blah, blah, blah, but the subtle but seismic change in identity and power. As much as I’d like to say that this life-changing experience affects both genders equally, currently I do not think this is true, and by-and-large for most families, the brunt is borne by the mother.

This is of course a modern-day phenomenon as even one generation ago; women grew up without expectation of financial independence, of autonomy, of economic power. They were defined by their husbands and felt no big loss when they settled down to have a family. They came from a position of inequitable power and continued.

For me, up until childbirth, I enjoyed financial independence. I was quite satisfied with my identity as a doctor with intelligent colleagues and friends, thank you very much. I had a healthy salary, I rented my own flat, I owned my own car; I bought whatever I wanted with my money. For a time, Banker lived in MY flat and drove MY car. At another time, I lived in his flat and drove his car. We shared the household chores. Our relationship was 50:50.

So where did it ever say, that once you pass a melon-sized being from out of your nether regions that that contract with your partner, with society, with your own self had to be torn away with your placenta?

From hence forth, I was no longer me. I was Mrs Banker, or mother of Big Sis and Lil Bro. Even though I had kept my own surname, once Big Sis and Lil Bro came along with their Dad’s monogram, it was inevitable that I would now be referred to as Mrs Banker. Staunch refusal to change my name on my passport led to my being interrogated at Heathrow airport for child trafficking as the official doubted my relationship to 2 year old Big Sis due to non-matching surnames. Thankfully, Big Sis came to the rescue as I started my feminist “Taking your husband’s name is an outdated sexist practice” rant at the official by saying “Why are you getting cross MUMMMY?”

I was still a doctor, of course, and yet, not the academic high-flying, arse-kicking-doctor-stroke-clinical-academic-jet-setting-to international-conferences-doctor I had set out to be. For ease of life, I went from full-time clinical work with academic productivity, to full-time clinical work with no academic productivity, to part-time clinical work, to part-time research work. It eased my life, but the loss of status and identity still tastes bitter. It’s only two steps and a push to considering an art-course, or maybe running a loss-making boutique funded by my husband to keep me quiet…I’m joking, but some jokes speak truth. Several other doctors I know have given up medicine when their children came along which is such a waste of talent, and yet, the NHS (like many other employers) does very little to support high-level part-time working, preferring to source doctors from abroad.

Stepping back in a career is sufficient to “affect the integrity of an individual’s social network”, as work is not just about money, but about esteem, about intellectual stimulation, about friendship, about intelligent conversation. It’s replacement with discussions about faecal consistency with other MAD mums, raucous bouts of “Jelly on a plate” to a mute baby, and various “telling offs”, rebukes, unrequested nuggets of parenting advice, raised eye-brows and generally being spoken to like an idiot, from teachers/ parents/ friends/ the supermarket check-out lady/ any random stranger, just doesn’t bear comparison.

And the first (and last) time Banker ever dared utter “What have you been spending my money on?”…that stuck in the throat. Never since graduation had I had to ask permission to spend money. I earned money; I spent it how I saw fit. Yet, with declining hours of work, come diminished income and the inherent shift in power dynamic in the relationship. As I am now “at home more”, there somehow passes an unspoken expectation that the days of shared laundry, cooking, cleaning and household chores are over. An unspoken expectation that money has to be “asked for”, and “kindly bestowed”, a nagging worry of “Could I manage financially alone, having stepped back on the career” should the worst happen and our relationship falter,  – or worse still, would I feel I could not leave?

At times I stared at myself in the mirror and barely recognised myself. I had turned into “Hockey-mom”. There is nothing wrong with Hockey Mom, but she was not who I had ever identified myself with.

But at least the children will be grateful for my presence won’t they?

The other day, Big Sis said: “Mummy, you’re lazy”

“Why?” I questioned.

“Because you only work 3 days a week.”

%$£”&*!! [Thought – not spoken]

I’m telling my story, but I know many other mums who have felt the same.

The treatment for adjustment disorder?

Nature’s anaesthetic.

Time.

Most of us learn to accept our fates, and “adjust” to survive.

Some of us find new pleasures in our new roles, however unexpected.

I guess that’s the beauty of life.

Caveat: some people do not get better from adjustment disorder, and their diagnosis shifts to depression. This goes for MAD too, and depression in mothers is pretty common.