Mania in Full Bloom: How to (not) cure mood disorders with kale and cold plunges

April 20, 2026

Lauren Grawert,  MD, FASAM, Author and Chief Medical Officer at Aware Recovery Care

Tom O'Connor, Publisher

Her Name Was Linda. 

She was about my mother's age. She had the same soft features, the same expressive eyes—but with the slightly disheveled energy of someone who had far more important things to do than brush her hair.

Linda was deeply creative. She sang constantly. She wrote songs about whatever was happening in the moment—sometimes about me, which was both flattering and mildly alarming. 

Linda came from extraordinary wealth. Her family lived on a private island—ferry access, sprawling waterfront property, the kind of place where wealth hums quietly in the background and distance becomes a lifestyle. The kind where money arrives monthly, reliably, predictably—but emotional support does not. It was the kind of arrangement that covered everything—except the quiet tax she paid in empty holidays, silent dinner tables, and a loneliness that no amount of money could erase.

While Linda's family funded her life, they did not participate in it. So Linda built her own world. And every spring and summer, that world expanded. Aggressively.

Bipolar Disorder Mania

Linda had bipolar disorder. Like clockwork, her mania arrived with the seasons. Winter Linda was thoughtful, musical, eccentric in a way that felt manageable. Summer Linda was something else entirely—an unmedicated Broadway meets conspiracy theorist with a no-limit credit card and a firm belief that sleep was for the weak.

In the warmer months, her sleep disappeared. Her energy surged. Her thoughts accelerated to a pace that made conversation feel like merging onto a highway at 120 miles per hour... in a vehicle with no brakes and a deafening soundtrack. The beliefs we could gently reality-check in the winter hardened into fixed, immovable truths—intensifying with the sunbaked ferocity of summer.

She had a few recurring ones. Her house was bugged. The police were monitoring her. And one particularly memorable summer… I was the daughter of Senator Lindsey Graham. This conclusion was based on exactly two pieces of evidence: I was from South Carolina, and I had a framed photo in my office of my brother standing next to him during a college internship. That was enough.

Senator Lindsey Graham

"Lauren Grawert Graham," she began calling me. Not as a question. As a fact. As a full rebrand.

During non-manic periods, I could gently challenge this. During mania? Absolutely not. The delusions upgraded from background noise to Dolby surround sound—unshakeable, fully formed, and completely uninterested in reality.

Which is how, one April morning, I walked into my office and was met with what can only be described as a floral event. Not a bouquet. Not several bouquets. An installation. Roses, orchids, peonies—arrangements so large they bordered on structure. The air was thick with perfume. It looked like I had either just gotten engaged to a billionaire or died.

At the center of it all stood Jamaal, our front desk coordinator, calmly holding a card. "To Lauren Grawert Graham," it read, "with deep admiration for your family's service to this country."

Of course. More deliveries came. Then more. By mid-morning, Linda had sent thousands of dollars' worth of flowers from the most expensive florist in town.

At one point, an arrangement was wheeled in that briefly blocked a hallway and, for a short time, became a legitimate fire hazard. And then I noticed—half of them weren't for me.

They were for Jamaal. During the season of mania, Linda had developed a full-blown crush on the shy front desk secretary. Despite him being half her age, openly gay, and her husband sitting right next to her during all appointments. Mania does not concern itself with logistics. Or demographics.

Police Engagement

Meanwhile, Linda herself was escalating. Her calls to the police became so frequent that she was on a first-name basis with entire precincts. I imagine them answering the phone with the resigned tone of men who had simply accepted their fate. "Hi Linda." And yet, when the question inevitably arose—why not hospitalize her? —The answer was simple. She refused. Firmly. Repeatedly. Unequivocally.

Linda had prior experiences with inpatient psychiatry that left her unwilling to return. And so we did something psychiatry has historically struggled with, but is slowly learning to do better. We respected her autonomy. And we tried—imperfectly, cautiously—to manage severe mania with psychosis in the outpatient setting.

We adjusted medications. Slowly. Hopefully. Knowing that during manic episodes, insight is often limited and medication adherence can be…aspirational. This was the balance. Control versus trust—stabilization versus dignity.

Eventually, as summer gave way to fall, Linda's mania softened. The delusions quieted. The flowers stopped. The police got a break. And Winter Linda returned. Grounded. Creative. herself again.

Lesson Learned

Linda taught me something I didn't expect. That need doesn't always look like need. That suffering doesn't always announce itself in obvious ways. It can live in beautiful homes. Hide behind luxury. Come by ferry and arrive quietly. Well-dressed. Well-funded. And still deeply in need of help.

Mental illness does not check bank accounts. It does not sort by zip code. It does not care how many layers of distance someone has built between themselves and the world.

The Great Equalizer

It is, in many ways, the great equalizer, which is why it's always jarring when I encounter the idea—now increasingly popular—that psychiatric illness is primarily a matter of choice. That mood fluctuations are only for the lazy.

With enough discipline, enough lifestyle optimization, enough journaling, sunlight, strength training, cold plunges, and a suspicious amount of protein intake, one can simply eat and exercise their way out of a genetic neurotransmitter imbalance in the brain.

It's a seductive idea. It offers control. Agency. A comforting illusion that biology can be overridden if we just try hard enough.

A compelling narrative, complete with a strong bench press and a cold plunge. For some individuals, lifestyle enhancements may reduce or even eliminate the need for medication.

But for many others—like Linda—it is not. Linda was not choosing mania any more than someone chooses a seizure or a myocardial infarction. Her brain was not offering her that option.

For her, medication was not optional. It was indispensable. And that distinction matters. When personal mantras about thriving without medication are generalized into universal prescriptions, something dangerous happens.

We begin to imply that those who still need treatment are simply not trying hard enough. We unintentionally begin to abandon the very patients who need us most.

Psychiatry is not unique in this tension. We don't tell patients with diabetes to throw out their insulin and focus exclusively on kale. We don't advise someone with severe asthma to "breathe more intentionally" and skip their inhaler.

We understand that Lifestyle Matters—but so does Biology.

Psychiatry is no different. Yes, medications have side effects. Yes, the system sometimes overcorrects. Yes, patients deserve better conversations about risks, benefits, and alternatives. All of that can be true.

And it can also be true that medications save lives. Mood stabilizers like lithium reduce suicide risk in bipolar disorder by more than 60%. Antipsychotic treatment in severe mental illness is associated with significantly lower all-cause mortality compared to untreated illness.

These are not abstract benefits. They are survival-level interventions.

We Should Question Psychiatry

The real danger isn't in questioning psychiatry. We should question it. Push it. Demand that it be more transparent, more human, more flexible, more personalized, more collaborative.

The danger is in swinging to the opposite extreme—replacing one imperfect system with an absolutist ideology. 

When we tell patients with severe mental illness that they should simply "try harder" instead of treating a biologically based condition, we are not empowering them.

We are stigmatizing them. We are abandoning them.

Linda didn't need less treatment. She needed the right treatment—thoughtful, individualized, sometimes imperfect, but grounded in the reality that her illness was not a failure of willpower.

It was biology. And some patients get better because of medication, not despite it.

When we move beyond policy debates, philosophies, and current culture wars, the question remains remarkably simple: What does this patient need to get better?

Everything else is noise.

---

Dr. Lauren Grawert is an Addiction Psychiatrist and Chief Medical Officer at Aware Recovery Care. She is double board-certified and treats both adolescents and adults struggling with mood, anxiety, and substance use disorders.

If you enjoyed this article, 

Please share it with a friend or colleague who might benefit from it!