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August 2, 2017

To The Bone: Controversy, Conversation, Eating Disorder Hope

To the Bone - Ellie in Hospital Gown

There has been a lot of buzz surrounding Netflix’s new film To The Bone, written and directed by Marti Noxon and starring Lily Collins.

Noxon and Collins both report having experienced eating disorders and it is clear that the intentions in creating the film were good. However, regardless of intention, no examination of mental illness is without its faults and risks. To The Bone is no exception in that there are things it did well and aspects that were missing or left unexplored.  

Accuracies

The Character Ellen

The film focuses on 20-year-old Ellen, who had to drop out of college due to her severe anorexia. Ellen is every bit the angsty and defiant young-adult, constantly emphasizing that she doesn’t see the point in life or love, bringing down those around her, and not letting anyone in. As cliche as it may seem, this portrayal is accurate for many who suffer from an eating disorder, using sarcasm, meanness, and superiority to cover up their deep fears and insecurities. This behavior can be off-putting to family and peers, as it was in the film, so it’s important to remember that this defensiveness is an attempt for a vulnerable person to keep themselves “safe.”

The Physical Impacts of an Eating Disorder

The film does well to portray the physical effects of eating disorders on its sufferers. Upon her intake appointment, Dr. Beckham notes that Ellen hasn’t had a period in awhile, an occurrence known as amenorrhea, a common symptom of anorexia. Dr. Beckham also points out Ellen’s fuzzy arms and informs her it is “lanugo,” her body growing more hair to warm itself since she has lost all of her fat and muscle.

The film also depicts characters such as Pearl, who has had a tube placed through her nasal passage, leading down her esophagus and into her stomach because she is severely underweight. We also see Megan, a female who seemingly has gained enough weight to become pregnant but loses her baby due to the disorder’s impact on her body. These instances are, sadly, accurate and common to those suffering.

Concerns

Inaccurate Portrayal of Anorexia Nervosa and Treatment Centers

People with anorexia are often incredibly thin, however, the film over-dramatized the emaciation of all of the girls involved, with only 1 of 6 of them not appearing visibly emaciated. This inaccuracy perpetuates the common misconception that one must be stick thin and “look sick” in order to be suffering from an eating disorder and warrant treatment. Perpetuating this idea causes many suffering to believe that they are fine because they “don’t look that bad” or that they aren’t “sick enough” to receive help.

To the Bone - Keanu Reeves and Lily Collins - Ellie Being Evaluated

Dr. William Beckham evaluating Ellie for eating disorder treatment in To The Bone / Netflix

The treatment center in To The Bone is also not realistic. Inpatient and residential treatment centers that were assisting such severe cases would not likely allow patients to eat unsupervised. The patients in To The Bone had altogether too many opportunities to continue engaging in unhealthy behaviors with seemingly no one intervening on the basis that “they decide whether life is worth living.”

This treatment center is more reflective of a transition center for those who completed treatment and are transitioning back to life on the outside, not those in the most severe stages of their disorder. While this choice may have made for a more interesting movie, it is misleading and didn’t go deep enough to show the reality of therapy or treatment.

Lack of Diversity

One of the biggest criticisms of the film is that it perpetuates the harmful stereotype that eating disorders are an illness mostly experienced by privileged, white women. However, studies are finding that young Hispanic and Asian girls report higher body dissatisfaction than white girls [3]. Additionally, “roughly one million males struggle with eating disorders” and that 25% of anorexia and bulimia cases are males [4].

While the film does show minority characters in treatment, they are not fleshed out and their stories are not truly told. This makes them feel more like “token” characters than valued stories that challenge, and deepen, the viewer’s understanding of who can be impacted by an eating disorder.

The one character that receives more screen time and challenges the stereotype is the male patient, Luke. However, even with him, we never get a moment where he discusses how that impacts his disorder, treatment, and recovery. Movies cannot flesh-out every character, but the film would have done much more to further accurate awareness of eating disorders had it given these characters small moments to create a story that other sufferers could see and say, “that’s me.”

Sam Thomas,  Founder, and Director of Men Get Eating Disorders Too, also took issue with film and the ways in which it downplayed the realities of eating disorders and highlighted contrived and unrealistic aspects to make a film that glamorizes the disorders for the sake of drama and reviews. Thomas stated: To The Bone has been highly condemned by the eating disorders community for all the right reasons.

It attempts to highlight the impact of anorexia but instead gives a confusing message. Eating disorders ought not to be glamorized for dramatized purposes but instead highlighted as a mental illness. Even the title in itself is deliberately controversial and sensationalist view, which indicates the ill-informed view of the makers of the program….Hopefully, Netflix will pull the film knowing the triggering and damaging nature it can cause to those with eating disorders.

The Family Dynamic

To the Bone - Promo Poster

To The Bone Promotional Poster / Netflix

Ellen’s family dynamic is described more than once as a “shit show” and, while aspects of their family dynamic are problematic, it isn’t the fault of the family that Ellen developed an eating disorder.  These are complex bio-psycho-social disorders with multiple factors that can cause one to develop an eating disorder.  At Eating Disorder Hope, we support and encourage refraining from judging family members and instead, looking for the strengths of the family to facilitate healing and hope for all.

Keanu Reeves’ character, Dr. Beckham, reports that he won’t be doing any more family therapy with Ellen because it wasn’t productive. In this, the film was off-the-mark. Studies have shown that familial involvement in the treatment process can go a long way in assisting recovery and preventing relapse [2].

If the family is not involved in the treatment process, little may change after discharge and the family could be left without the tools and guidance they likely desire to provide the most support possible for their loved one.

Collins’ Behaviors to “Look the Part”

Lily Collins reports that she has a history with eating disorders but that she lost weight “as safely as possible” for the film by hiring a nutritionist. It’s ironic that the film continuously emphasizes that the idea of someone with an eating disorder “having it under control” is false, yet, the actress herself maintains that she lost this unhealthy amount of weight but “had it under control.”

It is this aspect of the film that is most deeply concerning. A woman in recovery adjusted her eating and exercise habits to lose an incredible amount of weight, risking relapse, and re-traumatizing herself for a movie. This alone can be triggering and send the message to those suffering that “there is a way to become thin like her in a healthy way.”

Nikki Dubose, author, speaker and mental health advocate states:  “I watched a little of To The Bone. As a former entertainer, I know that losing weight for your craft is seen as an art, but I also know that the environment can push you to engage in maladaptive behaviors.

I nearly lost my life trying to fit into what the entertainment and modeling industry wanted, and I don’t think it’s wise for an actress with a prior history of an eating disorder to lose that much weight, neither is it wise for the studios to cast someone who had an ED. It can be very triggering to the brain, emotions, and body. “

It is disturbing to view Collin’s body in the film. While some patients with anorexia do appear as Ellen does, not all eating disorder sufferers look like Ellen. She is a character portrayal. It is Lily Collins’ body we see and to realize that is to realize that she put herself in serious danger for this role. A recovered person restricting food intake and exercising excessively to lose an unhealthy amount of weight, at best, is putting themselves at risk for relapse and, at worst, is already there.

Should I Watch To The Bone

To the Bone - Ellie on Scales

Lily Collins stars as Ellie in To The Bone / Netflix

It all comes down to: “is this film safe to watch?” While it attempts at being informative and telling the story of eating disorders were well-intentioned, To The Bone missed the mark in too many areas that are of significant importance.

After stating that this movie is not recommended, CEO of Timberline Knolls, Colleen Kula explained why perfectly, saying, “the risk of harm due to the topic, images and storyline is just too high. At Timberline Knolls, we treat women and girls who relentlessly strive to break free from the grip of eating disorders. When recovery is finally realized, relapse can still happen. No movie is worth such a possible outcome.”

Where Do We Go From Here?

At Eating Disorder Hope, we believe that every wave created in the eating disorder community can be used as a launching pad for good. True, To The Bone missed the mark in some important areas.  However, it has sparked a lot of thoughtful conversation about eating disorders and increased eating disorder awareness.

This film showed one story of the 30 million who experience an eating disorder [5]. Who else is out there? If you didn’t feel your voice was represented in the movie, make yourself heard!

Eating Disorder Hope relishes the opportunity to share eating disorder recovery stories and we invite you to submit your story for publication consideration in our Inspirational Eating Disorder Recovery Stories online library.  The only way we can combat the stereotypes of what an eating disorder is and who can experience them is to tell stories that show otherwise. There is value in your experience and your story, make it known.

The film may not have generated the discussion everyone hoped for, but it did create a productive conversation. When you hear someone talking about it, point out the pros and cons of the film.

Listen respectfully to all views, share your experience of eating disorders, and keep the conversation going and point it in the right direction.  You can use any conversation about anorexia, bulimia, BED and other forms of disordered eating to increase sensitivity and awareness in society.

Finally, if you have already watched this film and are unsure of what to do, or you were purely triggered by the trailer, remember that you are not alone. Listen to your triggers and take them seriously, they will tell you a lot about yourself and your recovery.

Even if you have considered yourself recovered for quite some time, do not ignore the gnawing voice of your ED and seek support and treatment by eating disorder specialists. Your life is precious and you deserve wellness and freedom from disordered eating.

 


About the authors:

Jacquelyn EkernJacquelyn Ekern, MS, LPC founded Eating Disorder Hope in 2005, driven by a profound desire to help those struggling with anorexia, bulimia and binge-eating disorder. This passion resulted from her battle with, and recovery from, an eating disorder. As president, Jacquelyn manages Ekern Enterprises, Inc. and the Eating Disorder Hope website. In addition, she is a fully licensed therapist with a closed private counseling practice specializing in the treatment of eating disorders.

Jacquelyn has a Bachelor of Science in Human Services degree from The University of Phoenix and a Masters degree in Counseling/Psychology, from Capella University. She has extensive experience in the eating disorder field including advanced education in psychology, participation and contributions to additional eating disorder groups, symposiums, and professional associations. She is a member of the National Eating Disorder Association (NEDA), Academy of Eating Disorders (AED), the Eating Disorders Coalition (EDC) and the International Association of Eating Disorder Professionals (iaedp).

Jacquelyn enjoys art, working out, walking her golden retriever “Cowgirl”, reading, painting and time with family.
Although Eating Disorder Hope was founded by Jacquelyn Ekern, this organization would not be possible without support from our generous sponsors.


Image of Margot Rittenhouse.About the Author: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.


References:

[2] Linville, D. et. al (2012). Eating disorders and social support: perspectives of recovered individuals. Eating Disorders: The Journal of Treatment and Prevention, 20:3, 216-231.
[3] Eating disorders in women of color: explanations and implications. National Eating Disorders Association. Retrieved on 07/29/2017 from https://www.nationaleatingdisorders.org/eating-disorders-women-color-explanations-and-implications
[4] Strother, E. et. al (2012). Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eating Disorders, 20, 346-355.
[5] Get the facts on eating disorders. National Eating Disorders Association. Retrieved on 07/29/2017 from https://www.nationaleatingdisorders.org/get-facts-eating-disorders


The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.


Published on August 2, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on August 2, 2017.
Published on EatingDisorderHope.com

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