We inherit more than eye colour and bone structure from our parents. We inherit rules, silences, habits, beliefs. We inherit the shape of our parents’ presence or absence, the flavour of their neglect and the confusion of thinking this is love.

Every week in my therapy practice I meet people living out their inheritance, their family dysfunction: re-enacting childhoods, becoming the parents they despised, clinging to survival strategies that are slowly killing them. “I think I have a problem,” they tell me, “but I can’t see it.”

American writer David Foster Wallace summarised the problem well:

There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says “Morning, boys. How’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes “What the hell is water?”

A fish doesn’t know it’s wet. A child doesn’t know her childhood is unhealthy.

While physical abuse leaves marks, covert dysfunction is absorbed as normal and most of us don’t question what feels normal. It can remain unrecognised until someone else – a spouse, a friend or a therapist – points it out. Sometimes loss, such as a divorce, is required for us to finally accept something fundamental, something we assumed was normal, needs reconsideration.

Oliver’s* father had spent the last 15 years of his life sleeping on a pullout sofa in his study. He even had a stationery cupboard converted into a wardrobe and used Post-it notes to communicate with his wife – it was a spectacular commitment to avoidance. He wasn’t the only family member to avoid Oliver’s narcissistic mother, a woman with strong but warped opinions. “Darling, you can’t date her, she works in a shop.” Oliver imitated his mother’s plummy Margaret Thatcher accent. “People like us don’t associate with people in service.” While the absurdity of that statement might be obvious, it wasn’t for young Oliver. What Oliver heard was that his family was special; what he didn’t hear was the silent second part: “ … and therefore alone, and therefore unable to seek help because needing help means you’re not special.” This is what I mean about water. You can be drowning and not realise it.

Despite rejecting his mother and idealising his absent father, Oliver had taken on features of both. He was highly avoidant in relationships and chased sexual conquests with the same desperate energy his mother pursued social status. Raised by a mother with a disordered personality, it was inevitable he would absorb narcissistic traits. When a family member urged him to try therapy, Oliver cut contact. When his long-term partner finally left (“You’re exactly like her, you know that?”), Oliver spiralled into depression. That’s when he found his way to therapy.

He was enraged at his partner: “I’m nothing like my mother! Who does she think she is!” I challenged that statement; Oliver couldn’t see he had partly absorbed what he hated. I asked him – quietly, carefully – why he thought different people kept making the same connection. He defended and justified himself and looked angry but eventually we sat in silence for a long time. “But I … ” he started and couldn’t finish. The air went out of him. Oliver glimpsed himself, finally, and it nearly broke him.

The dysfunctional things that happened are easier to see. What’s harder to grasp are the things that didn’t happen – emotional safety, stability, nurturing. I asked another client, Kate*, how she survived 25 years in a marriage where she felt completely alone. The answer was in her childhood bedroom. She had spent her early years alone in her bedroom silently eating toast she had made herself. At age six she was making and packing her own school lunches. By seven she was taking her younger sister to school on public transport. She learned early to never ask for help. For Kate, neglect was normal. Kate swam in loneliness.

While seeing the water is hard, getting out is harder. Kate, now a nurse – perhaps inevitably – took a long time to open up. She understood intellectually the connection between her lonely childhood and lonely marriage, but admitted feeling deeply uncomfortable being vulnerable. I tried to slow the pacing within our sessions, but even that felt like too much. In our last session, Kate sat with her arms wrapped around a cushion, looking at the carpet. We’d been talking about what it might mean to leave her marriage. What it would require of her. To believe she deserved something.

“I’ll think about it,” she said. We scheduled another appointment, but I felt the particular unease I feel when I sense a client isn’t coming back. Maybe it was the way she wouldn’t quite meet my eyes, or a slight pitch change. I hoped she would, but I understand why some don’t. Some see the water but choose to stay submerged. The alternative – opening yourself up when you’ve spent a lifetime closed – means feeling everything, all at once. For some people, that doesn’t seem survivable.

What haunts me is not so much the patients sitting in my office, it’s those who never arrive. How many people are losing decades – entire lives – in water they can’t see? And even when they do see the water, sometimes, like Kate, that isn’t enough. Not every adult escapes their childhood. Some do – slowly, painfully, one breath at a time – but for many, the water is just too deep.

Oliver comes to me on Thursdays. The work of learning a new way of being – one without his mother’s narcissism or his father’s avoidance – is ongoing. Sometimes I see his mother’s snarl superimposed on his face, then his father’s silence dominates, and then there’s this other thing: Oliver showing up, catching himself. I don’t know who will win. Learning what a healthy relationship feels like takes time, but now, at least, Oliver knows what water is.

Kate stayed in the water. Oliver is trying to surface. I don’t know which takes more courage: the staying or the struggling. Maybe they’re the same courage, just differently expressed. Maybe we’re all just doing the best we can with the inheritance we got.

*All clients are fictional amalgams

In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org