Well, it’s been quite a while since I have posted. University had me drowning in more tedious essays, meticulous lab reports, and mundane reading assignments than anyone could have ever imagined. Once summer break started in June, you’d think I would have felt relieved and would have started blogging again . . . .well folks, that’s not how it happened. Just two weeks after I was freed from the obligations of the world of academia, my family and I moved. Now that my boxes are unpacked, I am FINALLY ready to reenter the blogosphere and what better way then to write a post about Netflix’s newest eating disorder film staring Lily Collins – “To the Bone”.
I have seen multiple films attempting to depict the horrific, merciless nature of eating disorders – For the Love of Nancy, Dying to Dance, Kate’s Secret. To my disappointment, all of these paint a very stereotypical picture of anorexia – a young female who is being suffocated by the drama of a dysfunctional family and decides to turn to self-starvation in order to escape the hurricane of problems in her life. Since most of these films are the product of the late 80’s and early 90s, I have reconciled the films shortcomings with the time they were created – a time when the understanding of neurobiology of eating disorder was almost completely nonexistent.
So, when I saw that Netflix released To the Bone, I had high expectations. I thought that this film would present the world with a true image of an anorexic patient – an individual suffering from a vicious disease caused genetics and abnormal brain biology, not by trauma or family turmoil.
But as I watched the story of “Ellen” (Lily Collins), To the Bone‘s anorexic protagonist, unfold, I was disgusted to find that the film’s writer and director, Marti Noxon, not only decided to paint an especially outdated picture of anorexia, but also failed to portray an accurate image of evidence-based treatment for patients struggling with eating disorders. In this blog post, I hope to shed some light on the gross misconceptions that tainted Netflix’s To the Bone.
Misconception #1: Family Problems Cause Eating Disorders
Right in the beginning of the film, it was clear Ellen was drowning in a sea of intense family drama. Her father was a obvious workaholic who put his paycheck first before his family. In fact, Ellen’s father was so disengaged, he never even appeared in any of the film’s scenes – he was only mentioned briefly in conversations. Ellen’s biological mother , Judy, was portrayed as a mentally unstable individual whose psychiatric ailments rendered her incapable of caring for Ellen as she grabbled with anorexia. Judy had also separated from Ellen’s father after she apparently came out as a lesbian. Due to Judy’s incompetence, Ellen lived with her step-mother, Susan – a grossly charismatic egomaniac.
This depiction of an overtly dysfunctional family supports the widely-held, but outrageously archaic, belief that the etiologic agent of eating disorders is an “anorexigenic” family system.
Nowadays, it is understood that merciless diseases such as anorexia nervosa and bulimia nervosa are biologically-based brain disorders. Neuroimaging has shown us that anorexic patients have significant brain abnormalities that likely contribute to the pathological behaviors that are exhibited. In the book, “Give Food a Chance: A New View on Childhood Eating Disorders” by the acclaimed Dr. Julie O’Toole, O’Toole also establishes that bulimic patients demonstrate severe neurological abnormalities as well.
The film’s writer and director, Marti Noxon, said in a statement that that she wanted to help the world “achieve a greater understanding” of eating disorders through the film. Well if Ms. Noxon desired to do so, why didn’t she show that eating disorders don’t just affect individuals trapped in broken homes? Myself and a myriad of other ED sufferers who I know grew up in families so incredibly normal that you’d think their family was the modern version of the Cleavers from Leave it to Beaver!
Misconception #2: Pretty Much All Anorexics are Sexually Abused
While Ellen was staying at a highly-unorthodox and absurdly incompetent (more on that later) “inpatient facility”, Ellen meant Luke – a fellow patient who seemed to want to get into Ellen’s pants a little bit too much. While the two patients were sitting outside together, Luke asked Ellen if she had ever been “touched bad” as a child since “that was common among Rexies”.
I was disgusted when I heard this line in the film. By Luke saying this, it was clearly suggested that individuals suffering from anorexia nervosa were most likely to be survivors of some form of sexual abuse. Believe it or not folks, but this is far from truth. In actuality, it has been shown that there is NO statistically significant difference in the incidence of sexual abuse between eating disorder patients and healthy individuals. Therefore, this particular scene in the movie propagates the myth that anorexics have all been “touched bad” as children.
Misconception #3: Treatment is Basically a Hotel for ED Patients
One of the most digusting things I witnessed while watching To the Bone was how Ms. Noxon depicted inpatient eating disorder treatment. In the film, Ellen was sent to a so-called “inpatient” facility managed by Dr. William Beckham – an apparent eating disorder specialist. This “inpatient” facility only had one supervisor to care for several very ill patients, patients were not supervised during meals nor were they given a meal plan to follow, the facility was not locked allowing patients to come and go as they pleased, and no effort was made to prevent patients from engaging in eating disorder behaviors (one patient purged in her room, another patient with BED could eat a full jar of peanut butter at every meal, the list goes on and on . . .). For anyone who has experienced inpatient treatment, they know Dr. Beckham’s facility isn’t anywhere close to what true inpatient treatment is like.
Inpatient treatment is the highest level of care for eating disorder patients and is for patients who are both mentally and psychiatrically unstable (read more about levels of care here). This level of care provides patients with STRICT 24/7 monitoring in a LOCKED unit, supervised meals & snacks, nutritional rehabilitation, medical interventions such as feeding tubes and IV hydration, and evidence-based individual and family therapies. The Joint Commission, a nonprofit organization that accredits and certifies thousands of US-based healthcare facilities, has also established a slew of guidelines that must be followed by facilities that care for patients suffering from eating disorders.
Some of these guidelines include . . .
- “For organizations that provide 24-hour eating disorders care, treatment, or services: The organization supervises the daily activities of individuals served as needed to prevent them from engaging in behavior that could be detrimental to their health, such as excessive or inappropriate exercise, inappropriate use of laxatives, or self-induced vomiting.”
- “For organizations that provide eating disorders care, treatment, or services: The plan of care, treatment, or services provides for sufficient nutritional rehabilitation to support regular and consistent weight when indicated (including expected rates of controlled weight gain of at least one pound per week) and/or measurable improve- ment in eating disorders behavior (for example, restricting, binge eating, purging).“
Clearly, the so-called “inpatient facility” in To the Bone fails to meet the definition of inpatient care as described by the National Eating Disorder Association and also neglects to follow some of the most basic guidelines published by the Joint Commission. If Ms. Noxon longed to produce a film that raised awareness about eating disorders, why did she decide to paint a highly inaccurate picture of eating disorder treatment?
All in all . . .
To the Bone is no different than any other eating disorder film produced. It continues to spread the idea that anorexics and bulimics are the product of family dysfunction, that anorexia nervosa is simply a physical manifestation of the trauma of past sexual abuse, and finally that eating disorder treatment is a free-for-all. In my opinion, Netflix should be ashamed of this film and Ms. Noxon should also apologize for her obvious lack of research in the subject of eating disorders.