To The Bone: A Film Review From A Mental Health Professional

Content warning: This post deals with eating disorders and may be triggering for some readers.


To The Bone is a new Netflix original movie about a 20-year-old woman, Ellen, who suffers from anorexia nervosa and ends up in a group recovery home for individuals with eating disorders. The official  trailer is included at the very end of this post.

Just like with 13 Reasons Why, there is a ton of controversy surrounding the appropriateness of this film. Many individuals, including many mental health professionals believe that this movie is very dangerous because they believe it will glamorize eating disorders. Some are even calling for Netflix to take the movie down.

Once again, just like with 13 Reasons Why, the majority of these individuals have not even seen the movie yet. Their fears however have some legitimacy.

Research suggests that it’s triggering for those who already have an eating disorder or who are  struggling with unhealthy thoughts surrounding eating, body image and weight issues to watch other people displaying eating disorder behaviors, even if it’s a story of hope and recovery.

With that said, I do not think that those individuals should watch this movie.

If you are someone or you are the parent of a child or friend of someone who is suffering from an eating disorder, I do not think this is a movie you should watch with them. Watch it yourself for sure, as I believe the movie gives some great insight into what it’s like to suffer from an eating disorder, but do not watch it with them  in hopes this will be a great conversation starter between the two of you. It could possibly do more harm than good.

There are definitely some images and events in the movie that can be triggering to certain individuals, such as the main character herself who is scary thin, to the calorie counting and food avoiding behaviors displayed throughout the movie.

Banning this movie however I do not agree with because it is just that, a conversation starter. It’s a movie that needed to be made.

My Issue With The Movie

My only issue with the movie is that Ellen, played by British actress Lily Collins is scary thin. This in itself can trigger individuals who already have issues with their body weight or have an eating disorder.

The real issue is that Lily Collins herself struggled with anorexia nervosa and bulimia nervosa at some point in her 27 years of life and writes a chapter about it in her book, “Unfiltered: No Shame, No Regrets, Just Me.”

For the movie she had to lose a lot of weight to look the part of a very unwell young woman. Although she reports that they did it in a healthy way with the help of a dietician, I still found it alarming that anyone would subject someone who already has a history of struggling with eating disorders, to losing so much weight and then this almost skeletal person is the main character that millions of viewers, some of who will be susceptible to triggers, have to watch on-screen for two hours.

As I watched the movie, before I did my research, I couldn’t tell if she was really that thin or if it was some tricks of the camera or make-up, but upon learning that she actually had to lose such a large amount of weight to play her character, it was just a bit unsettling.

I’m not sure if this film could have been done any other way.

Anorexia Nervosa Versus Bulimia Nervosa

Unless I missed it, the one thing I don’t think the movie did a good job on was differentiating between anorexia nervosa and bulimia nervosa. People tend to think that the only difference is that those with anorexia nervosa severely restrict their calories while those with bulimia nervosa eat and then purge (vomit) in order to control their food intake.

However, there are two types of anorexia nervosa.

One is the restrictive subtype that is more of what people are familiar with. They rarely eat, count calories religiously and may use laxatives, but usually do not purge. The second subtype is the bingeing and purging subtype. These individuals are more like those with bulimia nervosa as they will binge (over eat) and then purge their food.

The main difference between the two is that individuals with anorexia nervosa have a difficult time maintaining the minimal amount of weight considered healthy and individuals with bulimia nervosa are usually at a healthy weight or even overweight.

While anorexia nervosa and bulimia nervosa are the two eating disorders people are most familiar with, other common eating disorders include pica, binge eating disorder, and avoidant/restrictive food intake disorder.

Most eating disorders last 6 to 8 years which is a large part of someones life.

While body image, food and weight loss are generally the focus of an eating disorder, they usually aren’t the underlying causes.

Issues that may trigger eating disorders include a history of abuse or trauma, bullying, parent relational problems, low self-esteem, personality disorders, substance abuse, difficulty dealing with conflict, genetics and feeling as if they have no control over their lives.

Millions of Americans suffer from disordered eating and they’re not all thin, young white girls. People who suffer from eating disorders come in all shapes, sizes and ethnicities from the rail thin to the morbidly obese.

I worked with a 10th grade Haitain-American girl, along with another therapist who specialized in eating disorders as well as a dietician for two years. She struggled with anorexia and it was some of the most difficult work I have ever done.

Eating disorders, just like most mental health disorders, are always hard and uncomfortable topics to discuss and many people would prefer to act like they simply do not exist or are something they never will have to deal with. That is why 13 Reasons Why faced such backlash and why To The Bone is as well. Avoiding these issues will not make them go away.

If people want to be angry with Netflix for making movies such as To The Bone then we also need to be angry with our media in general because it glamorizes weight-loss and thinness. Girls as young as elementary school have started engaging in unhealthy diets and calorie counting due to the images they see on a daily basis through our media.

Marti Noxon, the writer and director of To the Bone says that the movie is based on her experience of struggling with an eating disorder and that the film is intended as “a conversation starter about an issue that is too often clouded by secrecy and misconception”.

So with some warning I recommend this film to anyone interested in learning more about what it is like to struggle with an eating disorder, but not to anyone who is already struggling with body image issues or unhealthy issues about food and weight.

The hope is that this film increases the conversation without increasing the risk of triggering others, but honestly I don’t know if it’s possible to have these type of conversations without anyone ever being triggered. It’s the nature of the beast.

If you or anyone you know are struggling with an eating disorder, please contact The National Eating Disorder Association (NEDA)at http://www.nationaleatingdisorders.org

 

 

13 Reasons Why: A Brief Review By A Mental Health Professional

13-reasons-whyI recently finished watching the Netflix original series 13 Reasons Why. I have to say that it is definitely worth watching, especially for those of us who are parents, work with teenagers or are in any helping profession.

Last night I was talking with one of my interns who said she recommended that her class watch 13 Reasons Why, but that her professor felt like the show idolizes and romanticizes suicide, so her request was rejected.  I think most people who believe this haven’t watched all 13 episodes of the show.

13 Reasons Why isn’t just about a teenage girl committing suicide, it’s about her life. It deals more with the way she lived and what she experienced than it does with her death. It’s  also about the lives that teenagers today live in with the age of social media, sexting and where embarrassing pictures and videos can be shared with a single tap of the share button.

The show deals with drinking, drugs, bullying and other uncomfortable issues such as rape and yes, suicide.

Some critics believe that 13 Reasons Why is a dangerous show that may actually encourage teenage suicide. They fear what is called a suicide contagious effect where publicized suicides have a tendency to increase suicides and suicide attempts among the general population.

While there has been shown a correlation in publicized celebrity suicides on an increase in suicides and suicide attempts in the general population, there isn’t any evidence of fictional portrayals of suicide in television or literature having an impact on actual suicides.

13 Reasons Why explores the lives of modern teenagers in a sort of reverse murder mystery where we already know who killed Hannah, the character who’s life the show is mostly focused on, but through the eyes of Clay, the other main character. We get to reconstruct the pieces to why this happened.

In the show, the parents appear mostly clueless about what’s going on in their kids lives. The bullying, the drugs, the alcohol, the suicidal tendencies. It highlights how so many parents today are so focused on their own careers, relationships and even images of the family being perfect that they can’t see the self destruction going on right under their noses.

I spent five years working in a high school as a mental health counselor, and many of the issues those kids were facing and the things they were doing, their parents had no clue about. Not just including the drugs, alcohol and sex, but also the anxiety, depression and low self-esteem. Most felt like they couldn’t talk to their parents, that their parents didn’t care or that their parents were already too overworked and over stressed to be “bothered” with their problems.

In 13 Reasons Why, there were many opportunities and people in Hannah’s life who could have possibly intervened before she got to the point of taking her life, but none of them did.

Her parents were too busy trying to keep their business afloat, her friends were busy being teenagers and not necessarily friends and the teachers and counselor all seemed rather clueless or even uncomfortable when it came to dealing with topics such as sexual assault and suicide.

Much like in real life, there wasn’t one single reason Hannah decided to kill herself. There were at least 13 as the title hints.

Many times when someone commits suicide, even with a suicide note left behind, loved ones are at a loss trying to figure out why the person did it. They may focus on one single event or reason such as depression or a break up, but usually it is more complicated than that.

In the show, much like in real life, Hannah talks about the many reasons that have led her to the point of taking her life. It doesn’t appear as if Hannah had been struggling with depression until the end, but that she lived a rather melodramatic life that was complicated by many different issues.

The show never really talks about mental illness or depression. Realistically, most teenagers who become depressed and suicidal don’t necessarily realize that they are suffering from a mental illness so it’s realistic for the show to never really talk about it using those clinical words.

The suicidal mind doesn’t think that way. It doesn’t think that “I feel really horrible about my life, but I know it’s just the depression talking”.  Instead it makes the person feel hopeless, that things will never get better and that no one cares for them; even if they say it or show it, the suicidal mind will tell the person that they are just lying to spare their feelings.

Most people think that suicidal people are weak or just aren’t trying to cope. The suicidal mind is exhausted from trying to cope, of caring, of being hurt and in pain. It’s a dangerous place to be and it’s where suicidal people spend most of their time, in their mind.

In the end, Hannah felt as if she had no other choice, but to kill herself. She was never offered an alternative to the despair, agony and loneliness she felt other than to turn to drugs and alcohol like many of the other students in the series.

“We all let her down… She took her own life. That was her choice. You, me, everyone on these tapes, we all let her down. We didn’t let her know that she had another choice. Maybe we could’ve saved her life, maybe not.”, says Tony, one of the characters on the show and Clay’s friend.

The suicidal mind believes that it has a choice; to live or to die. Only the suicidal mind doesn’t fight fair because it is overly emotional, irrational, unrealistic and incredibly persuasive.

For those, who are afraid that the show will increase the likelihood of suicide or suicide attempts in teenagers, I suggest watching the entire season before coming to a conclusion.

The show deals with the uncomfortable issues facing teenagers in our society and in the least it’s gotten more people talking about those issues which in itself makes it a show worth watching and I’m glad it got renewed for a second season because I hope it can further this much needed discussion.

If you or someone you know is having suicidal thoughts, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or text “help me” to the Crisis Text Line at 741741.