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“To the Bone”: A Psychologist Weighs In On the Controversy

  • by Dr. Melissa Miller
  • July 14, 2017
  • 0
‘To The Bone’: A Review by a Psychologist Who Specializes in Eating Disorder Treatment

On the heels of 13 Reasons Why, “To the Bone” is another highly controversial film that debuted on Netflix today. It is the story of a woman who struggles with Anorexia Nervosa and her rocky journey towards recovery. As a clinical psychologist who specializes in treating eating disorders, I’ve noticed a lot of fear and anger raised about To the Bone.” The trailer gave us a taste of what we feared to be a triggering, tip sharing, tutorial glamorizing eating disorders. We’ve been anxious about the release of this movie, and now that I have finished watching it I can finally break down everything you need to know about watching this movie responsibly.

I will be honest; I didn’t want to like this movie. I saw the trailer and like all my colleagues I felt nervous.

Since the debut of 13 Reasons Why, I hear from therapists about the noticeable rise in suicidal ideation in their high school clients. The last thing the world needs is an increase in eating disorders, we are already dealing with an epidemic.

So I need to have a huge disclaimer that this first section of the movie review is strictly for people who are not deep in the throes of an eating disorder or newly recovered.

Review

Strictly from a movie standpoint, I honestly loved this movie and this story. Marti Noxon wrote this film based on her experience with an eating disorder, and her message and vision were spot on. This depiction of the life threatening battle with an eating disorder was honest, real and raw. In our society where this very real disease is still often viewed as a choice or vanity, this movie paints a very real picture and has a lot of messages about what eating disorders are and are not.



One of the most powerful aspects was watching the main character Ellen (played by Lily Collins) surrounded by family members who were desperate to find the cause, and therefore the answer, to her eating disorder. Many families go through this very real struggle. They feel like if they could just hit the nail on the head for the cause, then there would be an a-ha moment and things could finally get better.

“Maybe I didn’t hug you enough when you were little?”

“Is it because we got divorced?”

“It is because your father wasn’t around, wasn’t it?”

“Am I sure our fighting was the cause of this?”

“What could I have done differently?”

Parents blame themselves, even though eating disorders are not caused by parents. Ellen’s family constantly questions her as to what else could the cause be. In a sadly hysterical dinner scene, Ellen’s step mother wonders if her eating disorder could be the result of her being a lesbian and too scared to come out.

“Why is this happening and why can’t you stop?” is the constant topic of conversation.

Ellen’s Family

Watching it play out with this family was so real and heartbreaking. As dysfunctional as this family was, they all really care about Ellen and feel helpless when it comes to her eating disorder. This is how families actually feel, and not just the parents. Siblings, friends, anyone who cares about a person with an eating disorder is affected by this disease and worries about how to handle things.

Everyone wants to help and they don’t know how, or they try to help and it is not helpful. Everyone wants to take away their pain, which is not possible, or helpful. Yet this dynamic of knowing everyone is worried, or angry, or wants the eating disorder to go away is pure hell for the person with the eating disorder. It makes them feel guilty, ashamed, and lonely. I was really impressed with how “To the Bone” depicted this dynamic, and I think it will hit home with a lot of families who have dealt with this monster of a disease.

I am also impressed with that this movie got it right about what eating disorders are, and what treatment needs to be about. Most people wrongly assume eating disorders are all about food or looking good enough. That once a person feels thin enough they will be happy, and this is all a choice.

In group therapy, a therapist explains, “This is not about being thin enough, it is about avoiding the struggle.” The truth is, eating disorder behaviors are an ineffective solution to a very real problem.

Instead of tolerating the pain or discomfort of a real problem, eating disorder behaviors help a person avoid experiencing the problem. Now everyone is guilty of avoiding negative experiences, so this part should be understandable. Everyone has ways they distract, numb or check out of life when it gets too hard. Anorexia is a way to avoid the pain of life. Keanu Reeves plays the role of the main therapist and says the most powerful truths about what needs to happen to recover from an eating disorder.

“Bad things are going to happen, that’s not negotiable. What matters is how you deal with them.”

“I can’t reassure you. This idea you have that there is a way to be safe, it’s childish and cowardly. Stop waiting for life to be easy. You are resilient. Face some hard facts and you can have an incredible life.”

It is direct, real, and true. I found the words used very powerful and correct for how we need to look at recovery from an eating disorder. Life is hard, we can’t avoid that. We need to be willing to deal with whatever may come. This is terrifying, yet accepting this is the path to freedom. I am so glad that Noxon gets it right. There are no easy buttons for recovery. There are no 4 steps to follow and then you will be fine. Recovery is the willingness to experience life, even when it is uncomfortable.

I loved this movie because I think it can spark some really important conversations for the world of eating disorders. So many people in our world suffer, and yet we still are not talking about it very much, spending much money on research, or getting accurate messages mainstream. I hope this film can debunk some myths about eating disorders. “To the Bone” is beautifully acted by Lily Collins and an entire crew who brilliantly depict people struggling with eating disorders. I love that the residential treatment facility is a mix of true to life people who struggle, which is all ages, males and females, all ethnicities, all sizes. Often time eating disorders are thought of as a rich white girl disease, which couldn’t be farther from the truth. I hope this film raises awareness because this is a serious issue in our world.

Statistics from the National Eating Disorder Association:
  • National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives.
  • 0.9% of women and 0.3% of men had anorexia during their life
  • 3. 1.5% of women and 0.5% of men had bulimia during their life
  • 3.5% of women and 2.0% of men had binge eating disorder during their life

Noxon is very vocal about wanting to raise awareness with this film, and even went as far as working with of UNC Center of Excellence for Eating Disorder developed a public service announcement with the cast. It is called 9 truths, and the powerful message can be viewed here:

Lastly, I hope this movie raises compassion for those struggling with an eating disorder. Since I am on the front lines treating eating disorders every day, each of these characters found a soft spot in my heart and I cried through a lot of the movie. I hope it does the same for everyone who watches it. I hope it makes everyone more caring, compassionate, and kind to those who are struggling and to the families who are struggling.

Is this movie a trigger?

Now the big question, how might this movie impact someone who has an eating disorder, on the verge of developing an eating disorder, or newly recovered? Here is where the realness of this movie becomes a double edge sword. This movie was very real, and it is full of little tid-bits of information about eating disordered behavior. I am going to say I would be very nervous for any adolescent to watch this, or someone who is flirting with behaviors. Parents: I would not let your kids watch this. 


If you are an adult and struggle, I would not watch this unless you are very recovery focused. This film shows the competitive ugly side of eating disorders, and if you are easily pulled into that, this is not a film for you until you are safe in recovery. This is always the dilemma about eating disorders. How much information is too much? Eating disorder group therapy can be a hugely positive component to recovery, but ONLY if there are clear strict boundaries to keep the group safe. Tip sharing or teaching is a very real and dangerous part of talking about the symptoms and behaviors of this disease. It is a fine line that Noxon walked in trying to show the realness of this disease while being socially responsible.

While I believe that “To the Bone” is okay for someone to watch who does not struggle, I do not think this film would be safe for someone who is not recovery focused. I think someone who is recovery focused but still struggling may actually get a lot out of the message of recovery this film offers, especially if they are really searching for a hopeful message. Not every therapist says the things so clearly that this film says boldly.

Graphic Imagery

via GIPHY

Now to the obvious controversy: the emaciated images in this film will be triggering to those who struggle. Noxon and Collins have said in interviews that they intentionally only showed a few images of emaciated bodies, and instead tried to focus on the life and emotions of these people. Here again, there was a fine line walked between wanting this movie to show the realness of the disease, but will indeed trigger those who are not in recovery. Mysko, head of National Eating Disorders Association hasn’t yet seen “To the Bone,” but said she hopes Netflix will provide resources for viewers who may be vulnerable. NEDA has reached out to the company asking that the film link to its help line and text line.

via GIPHY

A representative for Netflix did not respond to an email inquiry about whether the film will include a link to treatment resources.

Dr. John Huber, the chairman for Mainstream Mental Health, told Fox News, Netflix needs to promote resources when the film is released for those who may be struggling with eating disorders. Twitter has exploded with calls for Netflix to use a ‘trigger warning’ on the trailer and movie.

https://twitter.com/lirioha/status/885805486691336193

Netflix did in fact put a disclaimer on the film:

The film was created by and for individuals who have struggled with eating disorders, and it includes realistic depictions that may be challenging for some viewers.


I am a little disappointed that is as far as Netflix went. It would have been helpful for them to be a bit more direct in the disclaimer as whom this might impact. I would have also liked to have seen them offer website resources for those who struggle. I don’t feel they went far enough, and hope that viewers find their way to the public service announcement created by the cast and crew.

Glamorous or Graphic?

The main questions raised by the eating disorder community were “Does this film glamorize eating disorders? Was this movie done responsibly?” I’m not sure I can agree that this film glamorizes eating disorders. Yet the scary truth is someone in the darkest corner of an eating disorder will find the life of Ellen (Collins) very glamorous and seductive. Again, I do not think this movie is appropriate for them. I think Noxon does an amazing job of giving a realistic portrayal of this disease, and the reality is this is NOT a glamorous disease or state of being.

The truth is, this film is out there and there is nothing that can be done about that. I hope that people are very thoughtful about if it is appropriate for their situation to watch this film, and if they do watch it, I hope it raises understanding, awareness, and empathy about eating disorders. 100% recovery is possible from an eating disorder, but this disease needs more attention, awareness, and research. Awareness could lead to prevention. When it comes to eating disorders, early detection and treatment are essential to recovery.

If you are concerned that you or someone you love may have an eating disorder, more information about warning signs can be found here.

 

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Dr. Melissa Miller

Melissa’s biggest problem when it comes to entertainment is wearing out what she loves. Movies like Bridesmaids and every episode of The Mindy Project, have been played hundreds of times in her house as background entertainment and never fail to produce a laugh. If a song strikes her, she will instantly download it and proceed to only listen to that song until it loses its sparkle. She thinks going to the movie theater is a huge treat, but is hoping someone can figure out how to make the popcorn taste as good as it smells. As a teenager, she loved scary movies, but now that she has kids of her own she gets very excited to have an excuse to see all the kids movies without embarrassment.

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