Adapted from a recent online discussion.

Dear Carolyn:

Literally minutes ago, my husband and I got into a fight, and he threw at me that I'm the source of his high anxiety and blood pressure.

My first reaction was to get defensive -- he's struggled all his life to manage his anxiety -- but now I wonder if I am the reason. His anxiety seems to have gotten worse when we got engaged three years ago. I'm always trying to be understanding and accommodating of his anxiety, which is at the point of ruling his life, so I was just sad when he said in anger that I was the source.

How do I handle this? He rejects the idea of marriage counseling, and will not follow up with doctors or the personal trainer I hired for him.

-- Am I to blame?

No doubt you are a key part of his health picture, merely by virtue of your prominence in his life.

I can assure you, though, that someone with high anxiety and blood pressure who "rejects the idea" of and "will not follow up with" three of the most obvious ways to improve his health is more of an enemy to himself than his spouse is.

Plus, unless you've abused or imprisoned him, he is ultimately responsible for his own well-being.

It sounds as if things have reached a point where you need to seek the expertise he refuses to, ideally with a reputable mental-health-care provider who can speak to both the anxiety and relationship pieces of the problem. Those doctors he won't follow up with are a good place to find a referral.

If counseling isn't an option for some reason, or if the process of seeing one is such that you won't get an appointment until weeks from now, also consider getting help from NAMI (www.nami.org). The help line might be useful to you -- 1-800-950-NAMI -- as might their support groups for family members.

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Hi, Carolyn:

It's not a big deal by any means, but I'm wondering -- what would your internal process, and external response, be to the sudden re-emergence of a former, decades-long friend, via a one-word Facebook email, "Hey"? It wasn't my idea to sever contact -- with no notice and no explanation -- but in the last several years, I've realized that it was definitely a good thing for me.

I am ignoring the email and will not re-establish contact. Guess I just feel irritated at myself for re-hashing bad memories in order to justify my decision, instead of feeling peaceful and compassionate, blah blah blah.

-- Anonymous

Sounds as if you muddled your own way to the best answer, but I can add that the muddle is nothing to be ashamed of. I think we'd all love to be "peaceful and compassionate," but for most of us there isn't much of either behind the curtain, and it's no small feat to summon enough for a calm exterior. For some reason, I'm stuck on the image of a busy restaurant -- calm up front, and don't look in back.

You didn't ask and don't need to hear, but some more affirmation: That Facebook "hey" is outreach designed to be ignored, if that's your preferred response.

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