Why It's Important to Analyze and Critique Movies Like 'To the Bone'

Editor’s Note: This post contains spoilers for the movie, “To the Bone.”

I believe it is important to critique “To the Bone” because media has a major role in the perception of eating disorders and can influence the attitudes of those with eating disorders, the public and professionals, and by proxy, affect how these three groups interact with each other. This could potentially have a real world effect on the uptake and success of treatment. For example, the film ignores media guidelines on reporting eating disorders by including frequent references to calories, weight and eating disorder behaviors, as well as images of Ellen at a very low weight.

While I want to support the medias attempts at raising awareness of eating disorders, I want them to raise awareness of all eating disorders. To pardon the pun, they are not a “one size fits all” affair and affect people of every shape, size, age, socio-economic status, gender, race and cultural or ethnic background. They are not always the common image portrayed of a young, well-off, white, straight, college-educated female.

As a woman with an eating disorder, who, throughout my years of struggle, has read and watched almost all known material that refers to eating disorders, I can safely say it isn’t easy to make a novel about anorexia nervosa, much less a movie that relies on visually communicating an illness. Unlike other mental illnesses, anorexia nervosa has, in my opinion, a long track record in the media displaying “shocking” images of emaciated bodies. So I was interested to see how the director intended to tell this story without that visual manifestation.

Well it seems to me that according to Hollywood, you can’t. The writer and director of “To The Bone,” Marti Noxon, who based the movie on her own experiences with the illness, had her lead actress Lily Collins, a woman who has openly spoken about her own struggles with an eating disorder, lose weight for the role. From personal experience, I know anorexia nervosa isn’t a “look,” or visual representation, and can affect people at all weights, despite what the title of this movie might make you believe. I didn’t wake up one morning underweight and suddenly meet tabloid expectations of how my illness should manifest. It was a slow, painful process, with many missed opportunities from medical staff to intervene, because in my opinion, we live in a society that seems to value thinness over health, or should I say: uses thinness to measure health.

The common perception that you need to be a certain weight or BMI to have anorexia isn’t accurate. I was sick prior to becoming underweight, and early interventions are shown to have a greater chance of a lasting recovery. The focus on weight through imagery allows those with an eating disorder to feel as though they aren’t “sick enough” or “thin enough” to need help. It also allows medical professionals to say things such as, “You’re thin, but not that thin” or, to suggest as one nurse did with me, that she was jealous of my figure. Even medical staff can sometimes seem to focus solely on weight and not on the psychological aspects of an illness.

“To The Bone” has been widely praised since it debuted at Sundance, and yet, it continues the vein of “sexy,” white women that seem to dominate the films about mental health; for example, “The Virgin Suicides,” “Prozac Nation” and “Girl Interrupted.” The debate about the morality or ethics of hiring an actress with a known history of an eating disorder, and requiring her to lose weight for the role so she could “look anorexic,” I believe has been greatly ignored.

Even attempting to justify the movie as a way of creating discussion and giving outsiders a glimpse into the world of the illness falls somewhat flat, as it did with Netflix’s other attempt at an original mental health themed piece, “13 Reasons Why.” This series also delved into the ever-present trope of self-destructive, young, white women. At one point, the nurse asks Ellen if she is a “cutter,” because apparently having a co-morbid illness such as depression or another mental health issue that manifests in self-harm is “overachieving,” and ignores the wide variety of methods a person can engage in self-harm behavior. I believe it equates a brevity to it that is unhelpful. Many who go to seek help because their mental health has overflowed into a physical manifestation, such as an injury to themselves, are judged by staff. The fact that it it happening  at all should be enough cause for concern, not just the method or the physical medical attention required to treat it.

Netflix is free to develop and create whatever media it wishes, free from the expectations of Hollywood. It could give a platform to stories that are diverse and more representative of the lived reality of its viewers instead on relying on tired tropes that sugarcoat the lived reality. Netflix’s numerous original and successful documentaries are able to act as an educational and eye-opening form of media, which proves that there is an appetite amongst viewers for stories and characters that reflect their own. However, none of the characters seem to have depth and act solely as brief plot points. The wide range of eating disorders, and their complexities have been overlooked. From brief references to pregnancy and loss with an eating disorder, to bulimic behaviors that help one patient circumnavigate the house rules. Each of these are key plot points that occur in passing that aren’t referenced again.

“To The Bone” also seems to gloss over certain dangerous realities of the illness such as osteoporosis or electrolyte imbalances. The film attempts to not focus on food. Dr. Beckham uses an unconventional style of treatment, insisting there should be no talk of food. There does seem to be a voyeuristic focus on food throughout the film, from the allocated mealtimes to the dinner enjoyed and spat out by Ellen while eating with Lucas, her love interest. Furthermore, this love interest asserts the power of love and heteronormative relationships will save her from herself.

Dr. Beckham isn’t unconventional in his approach. An interest in weight restoration or more regular meals is common in some recovery and inpatient treatments, as a starved or malnourished brain isn’t able to engage as fully in therapy as a fed brain is. The clients are weighed, have items taken away from them when inpatient (not always getting an explanation from staff as to the reasons) and are closely monitored with privacy becoming a fond and distant memory, a sharp reminder of my own experiences of monitored bathroom breaks and showers from staff regardless of their gender or whether I was comfortable with being viewed. This idea is reflected in Dr. Beckham’s insistence on the removal of doors, so as one client remarks, there can’t be the “Rexie Olympics” if they are watched.

In my opinion, a quiet, patriarchal element sneaks in through Dr. Beckham’s dominance over his mostly female patients. His influence seems to stretch to Ellen when he alludes to her name not fitting her, so she subsequently changes it to Eli. This patriarchal representation of a male medical doctor who is “here to save all women” isn’t too far from my experience. I have had one doctor insist my eating disorder would be “fixed” if I simply found a man and had sex, because somehow sexual intercourse would invariably improve my own self-worth and body image. This narrative has got to end.

The very inclusion of a romantic, savior storyline is ludicrous to me. The ending (major spoiler ahead) is basically an odd dream sequence. It is layered with references to the Anne Sexton poem “Courage” that the quirky Dr. Beckham introduced to the group as part of his “unconventional” approach. In this scene, Lucas seems to act as a guide to her recovery.

I believe Ellen’s statement in this scene, “I’m sorry that I’m not a person any more, that I’m a problem,” is poignant because medical professionals can lose focus on the fact that their patients are people with feelings — not just diagnoses.

I believe the fact that in the film her dysfunctional family is used as the focus of why she has an eating disorder perpetuates the idea that an eating disorder could be the result of parents alone and ignores the wider influences. It does touch on how an eating disorder doesn’t simply affect the person afflicted, but their wider social circle. Ellen’s step sister says, “It’s my life too, you know. I don’t get to have a sister.” Eating disorders have a wider impact than many might realize. While I acknowledge and recognize the pain of those around me, I do so with the expectation that they recognize mine.

Hopefully, the more we talk about eating disorders as a serious mental illnesses, the more we can tear down the walls of stigma that discourage people from seeking the early intervention that provides the best outcomes for recovery. “To The Bone” is not a movie I perceive to effectively and successfully navigate the line between accurate representation and glorifying a topic. Eating disorder recovery is not all fun and games. It isn’t a massive sleepover in a house with others. There is a serious outcry over the lack of services and early intervention than can cater to the complexities of severe eating disorders that might come with co-morbid issues.

“To The Bone,” from the very start, reduces the complexities of eating disorders and anorexia to merely being issues about food that make someone unhappy and thin. If this is the main achievement of the film, you have to wonder what it has achieved at all.

If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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Screenshot via Netflix YouTube channel.