(Yet Another) Eating Disorder Psychologist’s Opinion About ‘To The Bone’

I was going to try to stay out of it-this firestorm of controversy surrounding the Netflix’s film, “To The Bone.” But this film, and the media surrounding it, has proven to be been pretty difficult to avoid. Maybe this is because I am a psychologist specializing in the treatment of individuals with eating disorders and body image issues. Maybe it’s because I have recovered from my own eating disorder. Or, maybe “To the Bone,” has been difficult to stay away from because it is a movie that provides an “insiders glance” into the world of anorexia-a world that often confuses and entices society. I first heard about the film about a month ago. My initial feelings were anything but positive. A movie depicting anorexia? An emaciated young actress? Crass jokes about calorie Asperger’s? “How is this going to be helpful?” I thought to myself. However, I made a pledge that I would fully make up my mind about the movie after seeing it, rather than react to the trailer preemptively. I have now both seen the movie, and taken some time to process my thoughts. My feelings about this film are complicated. I tried to view the movie from a multifaceted lens- first, as someone who has recovered, second as a concerned clinician, and third, as a member of our general society. "To The Bone" tells the story of Ellen, a young woman struggling with anorexia. Notably, both the star of the film, (Lily Collins), and the film’s director (Marti Noxon) have struggled with eating disorders in the past. Advocates for the film hold that this intimate knowledge-that of the unique struggle that comes along with an eating disorder- makes this movie deeply insightful. I agree with this. I think eating disorders are incredibly complex, so firsthand experience can be helpful when trying to convey the seriousness of the illness. I think that complexity is conveyed at times in this film. At other times, it seemed to be meant more for entertainment purposes, and hence oversights and simplifications occurred. I try hard in both my personal and professional life to stay out of the extremes- the “absolutely right” or “absolutely wrong” style of thinking. So here are my “grey area” thoughts about “To The Bone”- the good AND the bad.The good:

• The lead character, Ellen, does a good job of conveying the gut-wrenching nature of this illness during several different points throughout the movie. This is not a movie that shows the story of someone who “dabbles” in an eating disorder, and in the next scene, is recovered. (Much like how eating disorders are often represented on television- a character develops an eating disorder, someone “scares them straight,” or they have a “light bulb moment,” and the next episode moves on to the next story line. Poof! Eating disorder gone.) “To The Bone” is a departure from this narrative, in that Ellen has been profoundly struggling with her eating disorder for years. She shows us some of the sense of hopelessness, or feeling of being “stuck,” that accompanies an eating disorder. There is a scene where Ellen asks her mother to feed her like a baby that is absolutely heartbreaking. This scene is uncomfortable-almost disturbing to watch. In it, we see these two characters in true despair and desperation, trying to identify the “root” of the eating disorder, and remedy it.  This type of desperation and despair is very much a real experience for many eating disorder sufferers and their families.

• Speaking of families, I felt that it was positive that Ellen’s family is shown struggling with her diagnosis. Her stepsister is particularly touching, in that she expresses anger AND sadness that she is losing her sister to an eating disorder. We see the frustration and “just eat,” pleas from family members, which is very much a reality for many people.

• There is a male character struggling with anorexia. This is so important to see because eating disorders have traditionally been viewed as female illnesses.

• That same male character is shown as slowly but surely recovering from his eating disorder. This is also profoundly important. Eating disorders are sometimes viewed as life sentences. Showing this male character mid-journey, making real progress, sends the message that yes, people with eating disorders do get better. Full recovery is possible.

• The therapist is shown as caring and invested. I actually liked Keanu Reeves’ portrayal of the therapist in this movie (a seemingly unpopular opinion). Of course there are some clichéd Hollywood lines that I flinched over (“I’m not going to treat you if you don’t want to get better.”) But overall, I think that he was shown as patient-focused, competent, and invested. This is a real departure from the typical bumbling-fool- therapist character in most Hollywood portrayals of this profession. I liked that he was real with the patients. I liked that he used “unprofessional” language. And finally, I liked that he emphasized the grey area of life- that is, the fact that there will always be good and bad in this world.

The Bad:

• As many critics have pointed out, this is a story that has been told before. We saw it in “For The Love of Nancy.” We see it in countless memoirs. The story of an emaciated, heterosexual, cis-gender, caucasian female lost in the throes anorexia. I appreciate that the director was sharing her story-that is her right, and, more importantly, an incredibly courageous thing to do. However, ideally, I think that the eating disorder community and society at large would have benefited from a main character that identifies as a marginalized individual. Furthermore, the main character could have struggled with an eating disorder other than anorexia (as research indicates that this is, by far, the most well-known and discussed eating disorder in our society). Alternatively, it would have been beneficial to see the main character struggle with anorexia while living in a larger body.  Talk about a conversation that has not been had! This would have shed much-needed light on the fact that eating disorders have no size or look, and that young caucasian females are not the only individuals that struggle with eating disorders.

• Binge Eating Disorder is poorly represented. I was so happy to see that Binge Eating Disorder was a part of the film. However, the character that struggles with Binge Eating Disorder is stereotyped- she is the only patient in the center that lives in a larger body, and she eats jars of peanut butter for dinner. I also felt that she lacked the depth that accompanied other characters- it truly seems as though there was very little thought put into her character, which is a real loss for the eating disorder community, as well as society.

• The family dynamics portrayed perpetuates a tired stigma-Research has demonstrated that eating disorders have less to do with family dynamics than previously assumed. Certainly, family dynamics can play into the development of some eating disorders. But the reality is, many individuals with eating disorders do not come from a dysfunctional family system. This is because an eating disorder can have roots in so many different areas-it is the perfect storm of environment and genetics.

• The way that treatment is portrayed is entirely inaccurate. I know of no treatment center that allows individuals to “eat what you want.” This “take it or leave it” mentality about eating would never lead to progress. Many individuals who are malnourished are not able to cognitively think in a forward-focused, linear manner (i.e. “If I force myself to eat this, I will start to feel better, which will lead to more productive therapy, and a better chance at addressing the root of my eating disorder.”) This is why treatment centers focus on providing so much support and guidance with eating.

• The rock bottom emphasis is dangerous. The idea that one needs to hit rock bottom to truly recover just isn’t true. Rock bottom is a disappearing goal post anyway. True rock bottom would be death, no? I like to borrow the terminology commonly used by Alcoholics Anonymous (AA) when discussing this elusive idea of rock bottom with clients- “You can get off the elevator at any floor.” This is not to say that eating disorders are choices, but recovery involves a series of daily choices. And there is simply no research basis to say that we cannot make these choices until we have a near-death experience, or a tragedy to rock us to our core.

• There is no emphasis on the “upward” part of the journey. The film was 95% eating disorder misery, and 5% (if that) upward progress in recovery. I understand that the film is made to entertain. Hence a movie about the daily, repeated choices and actions that slowly lead to recovery would not draw an audience. But I still think that recovery-and specifically hopeful, forward progress in recovery- could have had more of a place in the film.

• Lily Collin’s weight loss has raised some eyebrows. Many have wondered (sometimes in anger) about the rational of having someone with a history of anorexia lose weight for a role. I also wondered about this, but ultimately came to the conclusion that the decision to lose weight for a film is not really my business. Collins herself has stated that the weight loss did not cause her to relapse-moreover, she called the experience “insightful” and “therapeutic.” What is my business, is how people connected with “To The Bone” have responded to concerns about Collins’ weight loss. Interviews from cast members have responded that Collins lost weight in a “really healthy way.” Collins herself stated that she lost the weight by eating “really clean.” When I paused to reflect, I tried to garner how my own past “eating disorder voice” might have used this knowledge against me. “If she can do it safely then so can you.” I might have heard. “She can eat really clean and go back to that body size without relapsing. You can too!” It concerns me to think that the individuals that I work with may experience similar thoughts. Being completely recovered and reflecting on what this thought may have felt like is one thing. But being immersed in an eating disorder and hearing this thought is quite another. And yes, I understand that those who are triggered from the movie should choose not to watch it. But honestly, who are some of the people that are going to be most interested in this film? Who are the people that are likely to stop and look twice at a magazine interview from the cast of “To The Bone?” People recovering from an eating disorder-that’s who. Hence I believe that the media coverage about Collins’ weight loss should have been more thoughtful.

 The Conclusion: This movie, like any film trying to depict a charged topic, has many flaws. I do not recommend watching it if you are struggling with your eating disorder, or are in recovery from an eating disorder. It is rife with triggers, and hence can do more harm than good if you have any belief that one of these triggers may impact you. I think that friends and family struggling to understand eating disorders, and struggling to be allies, could potentially benefit from watching the film. I say potentially because there is also a chance that the stigmas and misinformation represented in the film could confuse someone trying to understand eating disorders and treatment. Ultimately, I was somewhat disappointed with the film. However, I will acknowledge that, impressively, it has prompted a (rather passionate) conversation about eating disorders, which will raise awareness.No matter what your thoughts are on “To The Bone,” please know that if you are struggling with an eating disorder, no matter what your body size, ethnicity, gender, or age-whether you have hit “rock bottom” or not-you deserve to seek out help from a professional. Eating disorders can be overcome, and full recovery is absolutely and 100% possible.-Dr. Colleen Reichmann