Dalits in Nepal have been confronting centuries of caste-based oppression since 1947, engaging in social movements advocating for dignity, equality, and freedom. Their political involvement began in 1951 and reached a pivotal point with their active participation in the People’s War (1996–2006) and the People’s Movements I and II. Recently, Dalits have been instrumental in the development of anti-caste legislation, such as the Caste-Based Discrimination and Untouchability Act of 2011, while also working to expand educational access and raise awareness about caste discrimination. Unfortunately, this progress has been accompanied by a disturbing increase in violent backlash, leading to what has been described as “caste trauma” (Soundararajan 2022), which has significant implications for the mental and physical health of Dalit communities.

It has long been established that caste inflicts both physical and psychological harm upon Dalits. Dalit activist B.R. Ambedkar describes caste as “a notion, a state of mind” that “resonates with one’s psychic makeup” (Ambedkar 1989: 68) and views untouchability as “an aspect of the social psychology of intergroup perception, a sort of social nausea of one group against another” ” (Ambedkar 1948: 143). His insights connecting caste to emotional health have prompted scholars to define caste as not only a social problem (Sharma 1984), but also a medical issue (Jadhav, Mosse, and Dostaler 2016; Gupta and Coffey 2020), and more recently a psychological problem (Geetha 2009; Jaspal 2011; Jadhav 2021; Jogdand 2023; Folmar 2024). Despite these important contributions, caste has largely been overlooked in clinical practice in Nepal, with limited exploration of how it manifests within biomedical settings and influences clinical care.

While medical and psychological anthropology in Nepal could provide valuable insights into how caste appears in clinical setting, the field has not been fully utilized for this purpose. Anthropologists from the discipline have documented caste as a main risk factor in producing mental health problems (Kiang, Folmar, Gentry 2020; Kohrt et al. 2009) and in shaping the mental suffering among Dalits (Folmar 2024). Despite this, the resilience of Dalits in navigating survival and healing amidst pervasive caste-based violence in Nepal has been largely overlooked, and this paper aims to shed light on it. Building on Parish’s (1996) model of agency, Panter-Brick’s (2014) idea of resilience and Vizenor’s (1994) concept of survivance, this study explores not only the struggles of Dalit mental health patients for survival but also their active efforts to resist oppression, maintain hope, and assert their agency. This paper is an outcome of nine months of long ethnographic study both clinical and non-clinical settings in Nepal. This research contributes to the anthropological concept of structural violence through the lens of resilience, shifting the focus from suffering to strength and challenging narratives that portray marginalized individuals solely as victims.