If he is in a meeting, he may excuse himself for a few moments of self-conversation. At his desk, he will put his palms on his temples and mutter his responses. “It is not soothing unless I’m responding out loud,” he said.

In short, he lets the storm pass while holding his ground, and the interludes have not hampered his work performance.

At times of acute stress, when the waves keep coming for days on end, he lightens his workload, taking fewer clients, and refrains from making important decisions. In 2001, not long after he sat in his bedroom with the gun contemplating suicide, he sought medical help. Doctors at a local clinic diagnosed schizoaffective disorder and treated him with antipsychotic drugs for about a month, until the episode subsided.

Over the years, he said, he has relied on medication to ride out extended episodes. He has managed without drug treatment since 2006, he said, but considers it a valuable safety net, to catch him if he falls.

And always, he leans on Patsy.

“I don’t have any reference for mental illness except for Joe,” she said. “And I tell him it doesn’t matter what you’ve suffered, you’re an adult now, you’ve got to put that aside. You have responsibilities.”

“I tell him everyone struggles with doubts, with fears — that it’s normal,” she went on. “Normal. And I remind him that he has children to help take care of.”

And so he has, more of them than most fathers will know. On a recent evening after dinner, he sat as serene as the Buddha on his couch as Patsy and the children took turns holding yet another foster child, a 2-year-old daughter of a drug addict who does not look people in the eye and will not eat. The Holts feed her through a tube running into her stomach.

“The one thing she does, though, is she’ll hug you tight,” he said, setting the girl on his stomach, which she squeezed for dear life. “See that, right there? You see what I’m saying? That just kills me.”