Stigma, Silence, and Survival: A Sociological Study of Mental Health Narratives in Nepal’s Terai Region

Mental illness constitutes a substantial and growing share of Nepal’s disease burden, yet it remains marked by silence, stigma, and systemic neglect. This qualitative study examined how mental health stigma is experienced and negotiated in selected communities in Bara and Parsa districts, Madhesh Province. Drawing on Goffman, Link, and Phelan, Foucault, feminist theory, and intersectionality, the analysis conceptualises stigma as a relational and structural process shaped by caste, gender, poverty, and migration. Data were generated through 40 semi-structured interviews and three focus group discussions involving 30 participants. The findings show that household silence can protect family reputation and marriage prospects while delaying disclosure, help-seeking, and support. Derogatory labels such as “pagal” reinforce exclusion, while women experience intersecting burdens as people living with distress and as caregivers. Youth accounts reveal tension between growing mental health awareness and persistent social sanctions. Participants further indicated a local gap between national mental health commitments and available services. Rather than estimating prevalence, the study identifies the mechanisms that produce, negotiate, and resist stigma and silence. Moreover, it conceptualises silence as a protective yet stigma-reproducing social practice and identifies context-sensitive implications for primary care, schools, caregivers, and community-led anti-stigma initiatives.