For no apparent reason, she began to cry. She cried during a physical exam. She lost weight. The doctor diagnosed mild depression. She kept up her daily regimen, but something had profoundly changed.
"I became more and more confused," she said.
Then came the crash.
At work on an August day, she simply fell over in her chair.
"That was the last time I worked. I was lost and gone for the next five years," she said.
Lerer has bipolar disorder, a brain disease that causes moods to swing from stupefying depression to mania. It affects 5.7 million American adults every year, according to the National Institutes of Health (NIH).
"I had a very happy childhood. I had no big tragedies. It was alarming the way I was slipping in body weight. I was disoriented, weeping — deeply ashamed. I had big glasses on and a hat pulled down over my face. I felt I had done this to myself," she said.
But Lerer has emerged from the ashes of her life to become a leader. Once so ill she could not focus or speak, she now facilitates a peer-support group for people with mood disorders. Lerer is tall, willowy and attractive. Twelve years after her first depression, she maintains equilibrium through a cocktail of medications. Depression and mania are temporary states for most people, manageable through medication and therapies, she said.
Often, family and friends don't understand the illness, and they don't know how to react. Well-meaning words and gestures may end up further eroding already damaged self-esteem and increase isolation, Lerer said.
People with mood disorders such as depression and mania don't "snap out of it"; and often they cannot respond to invitations for help or even offer a thank you for cards or gifts sent, she said.
At one point, Lerer had a plan to kill herself, and she was happy to have figured out a way out of her depression. She thought she was a genius, she said. Such is the skewed thinking of someone in a manic state. Mania is characterized by extreme elevated mood, agitation, irritability and rapid talking and thought.
"I had the seat of the car down and tape around the exhaust pipe. My husband came home early. I came back to the garage and said, 'Sweetheart, I have to go to the hospital now.'"
Eighteen electroconvulsive treatments did not relieve her depressive symptoms, and she barely recognized herself after losing 35 pounds.
"I stepped out of the shower and screamed when I saw myself in the mirror. I said to my husband, 'What happened to me? Have I been in an accident?" she said.
A Realtor friend took her to Stanford Department of Psychiatry for peer-group support.
"There is an underworld walking right by you, Katherine, and the mentally ill look just like us," her friend said.
Lerer sat looking around at the other group members and thought she didn't belong.
"You don't accept this" at first, she said. But it became her place of refuge.
"It's the only place where you are not embarrassed; you are not ashamed of yourself," she said.
Lerer wrote about her experiences in the Journal of the National Alliance on Mental Illness and in Psychology Today. And she began running a peer group at Stanford and received training as a facilitator — big steps for someone who couldn't talk at all, she said.
She now facilitates a peer group affiliated with the Depression and Bipolar Support Alliance, the largest mental-health support organization in the country, she said.
During the first three Wednesday evenings of each month, a drop-in group meets in a rented Palo Alto office to discuss mood disorders and everything from struggles with their illness to what to put on a resume after being unable to work for months or years.
Mood disorders have many faces. Some are unipolar and have only depression; others are bipolar, which also have varying features, Lerer said. Some have psychotic elements; some have schizophrenia. A small number, perhaps one percent, have mania.
Fourteen people clustered around conference tables on a recent Wednesday. Some of their faces are familiar. They are doctors, nurses, software engineers, teachers, certified public accountants, artists, gardeners and professors.
(Because of the stigma attached to their conditions, their real names are not being used in this article.)
"I haven't been out much for four months. I worked in health care. I tried to do everything myself. I realized I need you guys. I need other people — to learn from each other," Janelle, a petite, professionally dressed Asian woman, said.
Newly diagnosed, Jean, a school facilitator, looked pained.
"I'm terrified of anyone finding out my secret. I work with teens. I feel the parents would be shocked if they knew. ... I just got an appointment, and I feel I wouldn't have the job if they knew. I feel ashamed," she said.
"Shame is a part of your chemistry," Lerer pointed out, referring to one symptom of the illness.
Lerer reached into the "question bag," where group members had earlier placed themes they wished to address:
Anyone have strategies for dealing with getting blood drawn?
"Take a phlebotomist to lunch," Bob said, to laughter.
"Ask for an infant-sized needle."
"Or a butterfly," Toni said.
"Tell them you're a fainter, and they'll get the cot right away," added Martina.
Dave reflected on a common misconception about psychotropic medication.
"I always thought taking meds would interfere with donating blood, but it doesn't."
Lerer dipped into the question bag.
"My neighbor has no mental and emotional boundaries. She's always asking about my mental illness. Any suggestions about how to deal with this?"
"When people ask me, I say, 'It's a long story. Let me get back to you.' They stop asking me because that's all they ever get," Jolene said.
A lively discussion broke out about how to respond to nosy acquaintances. Many had stories of the neighbor who feigned concern to pump for information, or the church lady's nervous hinting when they hadn't shown up for Mass for a few weeks. How to change the movie-picture image of mental illness?
Direct people to bipolar-disorders Web sites, a woman suggested.
Research shows that people in mood-disorder peer groups have shorter hospital stays (7 days versus 25 days) than those who do not attend a group. Nearly 86 percent stick to their treatments. A higher percentage have reduced psychiatric symptoms, increased coping skills and less need of professional services.
Lerer pulled another question from the bag.
"When days are tough, and you are unable to get up or eat something, what do you do to recognize that you are leading a normal life?"
"I get up. I tell at least one person that I'm having a bad day. I feel better. I'm not alone with it," Jean said.
For information about Katherine Lerer's mood disorder group, e-mail firstname.lastname@example.org or visit Depression and Bipolar Support Alliance at www.dbsalliance.org. Also visit the National Alliance on Mental Illness at www.nami.org.