In Metabolic Living, Harris Solomon takes us to Mumbai, India’s largest city, to find out how people deal with illnesses attributed to modern food habits, especially to the overconsumption of fatty and sugary foods. He aims to show that metabolism provides a prism of the anxieties and tenshuns of urban life in India. The book comprises chapters on a huge variety of topics, ranging from obesity, to food adulteration, to surgical procedures on the digestive tract. Solomon presents richly detailed insights into life in Mumbai and of clinical consultations between patients and specialists in metabolic illnesses.
The choice of “metabolism” as both a topic and a conceptual frame is, in some ways, straightforward. As many other scholars working on India have noted before, food and eating are so central—in relations of kinship, caste, care, hospitality, ritual, politics—that one could hardly go wrong with foregrounding them. As one of Solomon’s nutritionists rightly emphasizes, “we’re a food-centered society” (165), and food, eating, and digesting are key themes in the anthropology of South Asia. Metabolism also provides an entry point to some of the epidemic diseases that India is grappling with, in particular, diabetes. Metabolism helps Solomon to discuss a gamut of medical problems, such as obesity, thyroid problems, gastric bypass surgery, and food contamination, alongside each other.
Nonetheless, there are some pitfalls in choosing “metabolism” as an ethnographic topic. Biomedical notions of metabolism are highly abstract and have only very limited traction in popular notions of the body, anywhere in the world. “Metabolism” may be a widely known term, and some of the building blocks of metabolic processes, such as “proteins,” “carbohydrates,” or “enzymes,” are terms most people will have heard. Yet only very few people will be able to say what they actually are and how they relate to each other. Elementary principles of metabolism—the chemical reactions that are involved in maintaining the cellular structures of living organisms—baffle most non-experts. Even the most basic ideas, such as the distinction between catabolism (breaking down molecules to obtain energy) and anabolism (synthesis of compounds needed by cells) is hardly the stuff of everyday conversations—and they never appear in the book either. Despite the centrality of metabolism in biomedical understandings of body, disease, and therapy (both pharmacological and nonpharmacological), what happens in metabolic processes remains beyond non-experts’ models of health. The conversations on “metabolism” reported in the book, both those between Solomon and his lay informants (“everything is normal now … because I took the doctor seriously”), or between clinicians and patients (“eat more salad”), tend to feel short of substance.
There are not many parts of the book where Solomon engages with the knowledge biomedical experts have about metabolism. Whenever we hear about concepts such as glucagon-like peptides or the Y-Y paradox, Solomon’s book is at its strongest. In my view, the history of the discovery and formulation of metabolism in the biomedical sciences during the past century should have been given much more prominence. Questions of transmission and local relevance, such as how biomedical notions of “metabolism” have come to India, or how biomedical views might agree or clash with Indian medical traditions such as Ayurveda, are barely addressed. The Mumbai meanings of “metabolism” remain a black box.
An incomprehensible agency of the individual “metabolism” is cited by patients who, despite all their best efforts at sticking to a prescribed food regimen, say that they should not be blamed for a lack of willpower: “No amount of responsibility and compliance can help patients if their metabolism doesn’t respond favourably to dietary treatment” (185). Metabolic problems are said to come from it being “slow” or “imbalanced,” but what does that mean, exactly? Solomon wants to pay attention to “food’s movements in and out of bodies and surroundings” to demonstrate “how persons and food interrelate in ways besides instrumental eating” (227), but we get surprisingly few details of this.
The black-boxing of metabolism is at odds with other current scholarship in medical anthropology and in social studies of science, where “how stuff works” matters greatly. It is difficult to imagine an anthropological study of, say, tuberculosis in India, that does not take into account what causes the disease, what the past and present epidemiology of the disease is, or how various drug treatments work. Why are neither clinicians’ nor patients’ understandings of metabolism explored at much greater length?
It could be argued that “metabolism,” in its biomedical definitions, is not the focus of the book, but “metabolic living.” Solomon defines metabolic living as “an actively ongoing process people endure to survive the porosity that all life entails” (9). Metabolic living allows to “explore the ways that people complicate and even dissipate boundaries across the skin and thus show how bodies and environments are mutually porous” (9). Solomon’s main reference is Landecker, from whom he takes metabolic living as a conceptual space that brings the somatic together with the environmental, the inside together with the outside. (If Landecker should be the reference can be debated; she explores how “metabolism is in history” and emphasizes changing bioscientific models.) A conceptual space of porousness and blurred boundaries has long been established in anthropological writings on Indian bodies, and Solomon rightly cites (in passing) McKim Marriott and others. These older writings on how substance exchange relations in India are simultaneously biological and moral do not need to unpack biomedical definitions of metabolism because they are interested in the co-constitution of self and society.
Yet how different kinds of people in Mumbai experience metabolic illness is not the theme of the book either. Solomon lived in Bandra, one of Mumbai’s richest suburbs, and met mostly Catholic East Indians, but why are there no direct lines between neighbourhood encounters and clinical encounters? We see Solomon walking through the city with a variety of people, but they do not walk in and out of clinics together. Solomon says as much when he points out that “Mumbai’s diversity … dissolved difference in ways that made cultural moorings difficult to isolate” (16). None of the usual themes in the anthropology of South Asia (e.g., how groups draw boundaries by distinguishing between vegetarian and non-vegetarian food; hierarchies of eaters and the eaten), nor the common themes in postcolonial histories of India (e.g., diet and nation-building; domestic versus public spheres) are taken up at any length. This makes some sense, as far as Metabolic Living is concerned with the present moment and its discontents with processed foods, plastic contamination, or lack of exercise. It also makes some sense because this is not an ethnography of a particular community. Still, I would have loved to learn more about the different knowledge effects of metabolic sciences among different kinds of people in Mumbai.
Stefan Ecks is Programme Director for Medical Anthropology at the University of Edinburgh, UK. His recent publications include Eating Drugs: Psychopharmaceutical Pluralism in India (New York University Press, 2013). His current research explores the crises of global psychiatry, health inequalities in India, and “habitography” as a different way of doing anthropology.