Living with Diabetes: Lay Narratives as Idioms of Distress among the Low-Caste Dalit of Nepal

Abstract

Among the Dalit community in Nepal, people consistently describe their diabetes in relation to stress caused by social inequality and social marginalization. Drawing on the illness narratives of 30 people from this community, I argue that through linking diabetes with stress as a result of caste-based discrimination, respondents use diabetes as an ‘idiom of distress.’ Respondents report that discrimination based on caste creates and aggravates their dire financial circumstances, resulting in the prolonged stress that causes and interacts with diabetes. Suffering with diabetes, and its ensuing financial struggles and accompanying stress, has for some led to suicidal thoughts and the preference of death to living with diabetes.

Keywords:

• caste-based discrimination
• diabetes mellitus
• idiom of distress
• Nepal
• social inequality
• death is better

ACKNOWLEDGMENTS

This research is done as part of a PhD with the Faculty of Social Sciences at Chiang Mai University, Thailand and was approved by an endorsed PhD advisory committee. I would like to thank my PhD advisors, Assistant Professor Thapin Phatcharanuruk, PhD, Professor Yos Santasombat, PhD, of the Faculty of Social Sciences, Chiang Mai University, Thailand, and Paul T. Cohen, PhD, Associate Professor of Anthropology at Macquarie University, Australia. Gratitude needs to be given to Human Development and Community Services (HDCS) Nepal for granting me leave to study, with salary that partially supported my research. Without the respondents, this research would not have been possible. In particular I thank the Nepal National Dalit Social Welfare Organization, The Samata Foundation and Lamjung District Community Hospital for putting me in contact with respondents. I am fortunate to have the support of Olivia Nielsen who was a far better research assistant that I could ever have hoped for. I cannot forget my family, my wife, and children, for their patience and support.

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Notes on contributors

Tirtha B. Thapa

Tirtha B. Thapa is currently undertaking research for a PhD in social science at the Faculty of Social Sciences, Chiang Mai University, Thailand, on the experiences of people with diabetes in the context of caste discrimination and medical pluralism in Nepal. Tirtha is also the Founder and Executive Director of the national Nepali, nonprofit and nongovernmental organization Human Development and Community Services.