Harris Solomon’s Metabolic Living ruminates on the absorption of “metabolic disease” in India as a bio-political index for “globesity.” No doubt, from a public health perspective the questions of obesity and its physiological effects weigh heavily upon national populations and the individuals that comprise them. The high economic, psychic, and physiological costs of obesity and its metabolic sequela certainly give rise to political as well as medical concerns (although whether obesity is a cause or an effect of metabolic disorders remains an open question). Yet the adoption of the category “metabolic disease” to encompass this complicated nexus reveals the limited ability that biomedical frameworks have to adequately address these “public health” concerns, in their most global and most local incarnations. Harris’s book therefore offers us a unique opportunity to reflect on how biomedical and bioscientific discourses have come to colonize the ways we think both about public health and about the publics for which it cares. Moreover, it provides an occasion to recognize the constraints—at once epistemological and ontological—embedded in these ways of making sense of the vital entanglements that constitute human existence and/as coexistence.

As a category, “metabolic disease” actually deconstructs itself. Since it is simultaneously a singular and a plural concept, it refers both to a generic dimension of biochemical dysregulation—which includes a wide range of specific conditions, including a host of “genetic disorders”—and to a particular syndrome (or cluster of syndromes) that seem to predispose some people to adult onset diabetes. This generic singularity troubles both the reigning ontological theory of disease and the concomitant localizations of disease in “the body.” Moreover, the very notion of (a) metabolic disease destabilizes the at once biopolitical and biomedical presumption that “the body” constitutes a self-unified and self-unifying field of biochemical transformations of matter and energy. Since metabolic disease makes evident the tensions that always potentially exist within such transformations, it unwittingly reveals the transductive co-arising of individual-milieu—which Francisco Varela called the “paradoxicality proper to the individual”—as simultaneously a condition of and a problem for the living organism. Yet, metabolic disease also enables biomedical discourses to conceal this vital paradox by rendering it as pathological. Placing metabolic disease under the sign of pathology, biomedicine not only denies the very paradox which enables us to continue living at all, but it also disavows that containing this paradox is what made it biomedicine in the first place.

The notion of metabolism only emerged in the middle of the nineteenth century, after the experimental physiologist Claude Bernard invented the concept “milieu intérieur,” and thereby precipitated (in Georges Canguilhem’s words) “the historical rupture which inaugurates modern medicine.” This rupture occurred both within medical discourse and between the organism and the world in which it lived. Until Bernard, organisms and milieus could not be conceptually separated, which is why no one before him thought that laboratory experiments on living organisms would yield true knowledge about them. Bernard, a committed vivisectionist, overcame this objection by doubling the milieu itself, and thereby conjuring the milieu intérieur as a meta-milieu. He proclaimed that the milieu intérieur constitutes the “real theater” of life, while the corresponding milieu extérieur only concerns the living in a mediated fashion by altering the organism’s own quasi-autonomous processes. Indeed, Bernard framed this quasi-autonomy in the language of liberalism (since autonomy is after all a political and not a biological concept) by insisting that the milieu intérieur makes the higher, a.k.a., human, organism “free and independent” (again political not biological concepts).

While all contemporary lab-based bioscience and biomedicine now depend on this conceptual innovation, unfortunately no one seems to have paid much attention to its oxymoronic overtones. After all, the literal implication of the phrase “milieu intérieur” would be something like “outside inside.” Yet, by incorporating milieu intérieur simultaneously within the organism and within the experimental discourses of biomedicine and bioscience, Bernard rendered this “outside-inside” contradiction superfluous, since for him only the interior defined the “real” domain of vital processes. Following in Bernard’s wake, questions concerning public health increasingly shifted from focusing on questions of living together (e.g., by insuring clean water, adequate sanitation, salubrious air, sufficient housing, unadulterated foods, etc.) to the individual, the modulation of whose milieu intérieur (e.g., through getting vaccinated, quitting smoking, practicing safe sex, or losing weight) would concomitantly alter the incidents of disease in the population at large. Harris’s careful exploration of the complications, literally the “foldings together,” that underwrite the increasing concern with metabolic disease in India exposes the failure of biomedically-oriented discourses to grasp the convivial nature that subtends the problem they seek to treat. Arguing that metabolic disease only makes sense meta-metabolically, Harris’s important new book helps us to understand that governing from the inside out leaves a lot to be desired.

Ed Cohen teaches Modern Thought in the Women’s and Gender Studies Department at Rutgers University. His most recent book is A Body Worth Defending: Immunity, Biopolitics and the Apotheosis of the Modern Body (Duke 2009). His essay “Gut Wisdom, or Why We are More Intelligent than We Know” appeared in the Commonplaces series on Somatosphere.