The Paradox of Healing: Caste, Care, and Clinical Harm in Nepal

Can spaces designed for healing simultaneously reproduce the very social hierarchies that generate suffering? Drawing on twelve months of critical ethnography at the Mental Hospital in Lagankhel, Kathmandu, Nepal, this study examines how caste—a historically entrenched hierarchy— becomes embedded in clinical practice, shaping institutional organization, clinical encounters, and the lived experience of Dalit patients. By theorizing caste as a vector of institutional harm and extending anthropological theories of structural violence (Farmer, 2004), institutional power (Goffman, 1961), psychiatry as social control (Foucault, 1971; Fanon, 1959), and postcoloniality (Chatterjee, 1993; Stoler, 2016) into the new terrain of endocolonial Nepal, it investigates whether and how psychiatric care systematically generates what I term "medical casteism"—a distinct form of iatrogenic injury normalized under the guise of biomedical progress. Ultimately, this ethnography contributes to global conversations about health equity and whether modern institutions can truly uphold the dignity of those historically deemed unworthy of care.