Why “To The Bone” Gets Anorexia Wrong (And How To Change The Narrative)

As an anorexia survivor, I am befuddled and stunned by To The Bone.

Not only is it “shallow, sexist, and sick” but it is not even a good movie. An article in the Atlantic says the film, “is a mostly unremarkable film about anorexia, in that it follows the model of virtually all existing films about the subject.” It is to be noted that as I’ve written before, almost all eating disorder movies are awful, so “following the model” is not great press.

I am not even going to elaborate here on my disappointment with Project Heal, a major eating disorder advocacy organization that publicly endorsed the movie and even had a viewing party for the film. In addition to this, most treatment centers were quiet on taking a stand, and as Laura Collins Lyster-Mensh writes in a refreshing departure from generic “viewing guidelines” put out by almost every eating disorder organization, “We are all under pressure to promote the film or just talk about it, which is also good publicity.”

Project Heal co-founder Kristina Saffran suggests in a BBC interview that To The Bone is meant for the general public, in that the movie aims to open up a larger conversation. In this blog, I’m going to be talking about my concern about this portrayal of anorexia to the larger community.

To The Bone will open up a conversation, but I’m not sure if it’s the right one.

I see the movie as Marti Noxon’s story and as her message of hope. Ellen/ Eli is a brooding twenty something, full of teenage angst and emo, pro-ana Tumblr drawings. Chocolate, dances in waterfalls, and somewhat hallucinatory, dreamlike moments compel Ellen/ Eli to choose life at the end of the movie… or so we think. The movie ends with the possibility of hope and new beginnings as Ellen/ Eli re-enters treatment.

If the film is indeed a loose adaptation of director Marti Noxon’s own anorexia struggle, viewers are led to believe Ellen/ Eli does end up in recovery. Noxon and fellow film actors consulted with Project Heal in the making of the movie and have done subsequent promotional eating disorder awareness campaigns.

The movie might seem as if it has a pro-recovery message, but it doesn’t.

Despite the movie ending with Ellen/ Eli choosing hope over despair and death,  I will argue that the movie highlights hope instead of recovery. 

Hope and recovery are separate but related constructs, and it is dangerous to meld the two concepts. You can have hope without recovery and recovery without much hope. Let me explain.

When I was forced went into treatment for the second and final time, I was not at “bottom,” or so I thought in my nutrient-deprived mind. I wanted a month longer to get to however much lower I could get my weight. Did I have a reason? Did I want to die? I didn’t have a reason, and I didn’t want to die when it came down to it.

I also did not have hope.

When I entered treatment, I subconsciously knew I didn’t want to die, but I had no reason to live, either. My starved brain and starvation-based depression had me living in a cloud of darkness. When the brain is deprived of nutrients, it does not function optimally. I was not capable of hope or feeling much at all, actually.

My first morning of treatment, I was given breakfast. I looked down at the plate, having not eaten breakfast for at least a year. My immediate thought was, “I guess I’m eating breakfast now.” And I ate breakfast. It was not “orgasmic,” as To The Bone would absurdly indicate. It was just breakfast.

So I ate. I talked about my depression and hopelessness with my therapist. In full disclosure, it didn’t get any better for months. I didn’t feel happy to be alive or worthwhile as a human being. Sometimes I don’t even to this day.

The big difference between Ellen/ Eli’s hallucinatory revelation and my story is behavioral: I sat down to breakfast. I didn’t fake my way through treatment. I went through the motions. I ate snacks that challenged me.

It was not perfect, easy, or fun, but I did it with the anticipation that perhaps someday, I would feel happy. Someday, maybe, I would smile and mean it, fall in love and feel it, and find a career and enjoy it. Maybe someday. But that someday did not come into fruition for a long time.

Sometimes, eating disorder sufferers have to do the hard work of recovery without a reward.

Sometimes, we don’t have the luxury(?) of hallucinating in a desert to realize life is worth living.

Sometimes, we are plagued with ambivalence years into recovery, or worse, relapse and feel deep shame for the perception of letting others down.

Hope is a building block of recovery, but it is not the only building block. It is great when it’s there, but if it’s not, oh well. Doing the hard behavioral work is what helps people recover.

To be candid, there is nothing that is recovery-focused in To The Bone. I suppose it’s great Ellen/ Eli finds hope and returns to treatment at the end of the movie, but if this were real life, she would have to find an actual treatment center. To The Bone glamorizes a “treatment” that is a) not treatment and b) provides unnecessary, misleading, triggering details of some people’s experiences.

There is little that is pro-recovery in the entire movie. As Collins Lyster-Mesh describes perfectly:

There are no recoveries or recovered people in this movie. No one is abused, mistreated, or dies, but no one gets well or does any of the actual work of recovery from an eating disorder, unless you call having visions in the desert therapeutic. Insurance may not pay for that, but there’s no waiting list.

In eating disorder treatment and recovery, there is no lasting hope for the future without behavior change. Behavior change is not the only facet of eating disorder recovery, but it is a necessary precursor to life. Does Ellen/ Eli do the necessary work to get better, including eating more than one bite of chocolate the entire movie? We don’t know- that has been an artistic omission, and it is an omission that comes with implications.

The pro-ana commune that is passing as a treatment center in the movie is just a bunch of sick individuals talking about calories, restricting, cutting corners, and doing push ups. On a human level, it’s boring and sad, but on an advocacy level, it is terrifying and sad. Nothing about this is remotely pro-recovery. If this was a real treatment center, Keanu Reeves would have at least 10 malpractice suits on his hands for medical neglect and involuntary manslaughter (also maybe sexual assault depending on the nature of these nighttime “house calls” he does).

What scares me is not that these “unconventional methods” of essentially negligence will become in vogue (they won’t).

What scares me is what the larger public will see. What scares me is the conversation.

What conversation will come from this movie?

The movie may showcase hope, but it depicts a lot of other things as well. To The Bone is graphic, insulting, stereotypical, and crude. There are too many shots of protruding bones to count. I am concerned others will, perhaps subconsciously, file this away as a normative anorexia experience, or worse yet, see this pro ana colony as normative treatment.

The anorexia conversation needs to change. Anorexia films portray the same story over and over– a tragic, rich, white, straight, emaciated female with a “dysfunctional family” has anorexia.

To The Bone puts Ellen/ Eli into a tragic, starving girl Hollywood “type.” She looks waif-like and tragic as her family members fight in family therapy. She is an artist, but it appears that she is not working or going to school. She is emo, makes witty comments, and always wears dark eyeliner. She and the others in her “treatment facility” are not only able to access treatment but are able to take months off without working.

In my opinion, Ellen/ Eli is not a sympathetic character. She is two-dimensional and lacks depth. Yes, she is snarky and has enough eyeliner to star in a middle school PSA, but she has no hopes or dreams. I can relate to the narrowing of life that comes with an eating disorder, especially since she is sick the entire film. However, it doesn’t lead to interesting character growth.

Eating disorders are small and narrow diseases, and so is this movie. 

Anorexia is complex and multifaceted, and I saw none of that in To The Bone. To be frank, I didn’t feel anything at all for the characters or plot except for disgust at the triggering details that were unnecessarily included. Although I am also a white woman with privilege who struggled for years with anorexia, I do not relate whatsoever to this story.

To The Bone might be part of Marti Noxon’s story, but it is only a small part. The interesting part of Marti Noxon’s story is one that is untold by this movie- how she overcame anorexia and ended up being a successful director. That is interesting.

We don’t know where Ellen/ Eli would be in 5 years. She might open a successful indie art studio in New York City, or she might be dead. The audience does not get a window into her life or recovery. That does a disservice to survivors and the general public alike.

To The Bone does not get a pass just because it opens up a conversation.

I would be horrified if someone went up to me and said, “Do people actually get fed with bottles as part of recovery?”, or, “Do you think her mom’s postpartum depression caused her eating disorder?”, or, “Ellen got to wait until she ‘hit bottom’ so that’s what I’m going to do,” or, “Do you have ‘calorie Asperger’s’ too?” The list of misleading portrayals could go on and on and on.

We do need to have frank conversations about eating disorders.

However, To The Bone is not an adequate medium for doing so. The work should focus on awareness of the anorexia experience but also recovery and dispelling myths rather than perpetuating them. And if we’re going to make an eating disorder movie, at least can it be good??

We can do better than this. Everyone deserves better.

 

80 (Mostly Sarcastic) Thoughts I Had Watching “To The Bone”

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  1. Movie starts off with Ellen writing “Suck my skinny balls” in art therapy. Love the way things are getting off to a brooding, angsty start already.
  2. Ellen and her sister are literally playing something called the “calorie game,” in which Ellen counts the calories of everything. Not sure why her sister is enabling such a weird fucked up game. Also most people with ED’s who count calories don’t play public games about it.
  3. Why is Ellen’s stepmom taking a “skinny” picture of her to attempt to show her how thin she is? When does that ever work? And what kind of weird parent takes pictures of her emaciated child to show someone probably with body dysmorphia she is too skinny?
  4. This movie is HEAVY in stereotypes here- the big clothes, the body hair (lanugo), someone asking Ellen about her emaciated self, “Do you think this is beautiful?” UGH.
  5. Dr. Beckham, Keanu Reeves, aka KR, is super hot and exchanging a weirdly flirty look with Ellen. On a human level, KR and Lily Collins are both super attractive and I get the sexual tension. In the context of this movie this is really weird and unethical, and I feel super uncomfortable.
  6. Now KR is checking out Ellen’s back bones while she’s in a hospital gown. So… he’s a psychiatrist who is doing a physical exam? What kind of doctor is this dude? I’ll tell you- it’s a doctor who doesn’t exist. No doctor does psychiatry with a little internal medicine on the side. But for now let’s go with it I guess.
  7. Why are there so many views of spines and protruding bones?? Like we get it she is skinny. Like scarily emaciated. Can we stop seeing pictures of this girl’s bones now??
  8. KR is saying some weird ass stuff: “I’m not going to treat you if you’re not interested in living.” Pretty sure doctors have ethical obligations to help people not die. Tbh sometimes people are treated for their own benefit without necessarily wanting to live. Also many people go back and forth about whether they want to get better, and they go through the motions of recovery anyway.
  9. I do appreciate the portrayal of the stepmom’s stupid comments, such as a cake in the shape of a hamburger that says, “Eat Up, Ellen.” Something similar happened to me and it was mortifying.tothebone
  10. There is so much dark brooding music in this movie. Why so much unnecessary angst? We get it. Ellen’s angsty.
  11. Now Ellen is entering treatment. I have a lot of questions about this treatment center, but I’ll start with this one- who is paying for this?? No discussion of money or insurance, which is always part of the picture unless someone is seriously loaded (ED tx is $$$$$$).
  12. Interesting how many people are seeking the “best” “unconventional” doctor and somehow have access to that level of care… No discussion of how many people DON’T have any treatment coverage whatsoever. The movie is clear: We are talking about people with serious privilege. Not just Ellen… anybody who is at this treatment center.
  13. Also this doctor is the “best” presumably because he is unconventional… where is the discourse around evidence-based treatment and actual treatment methods that WORK? Flirty, waterfall-going, existentially-empty doctors who run unsupervised programs are not generally go-to treatment options for young adults who are pretty much dying.
  14. Ellen meets a British guy named Lucas, and he is giving her a tour around the treatment center because apparently in this treatment center there is no staff (begging the question of why any normal human being or insurance company would pay for this).
  15. Note the fact that everyone is really preppy looking and white minus Lucas and one black girl. Talk about playing into the lack of diversity eating disorder stereotype….
  16. This group therapy session… just, ugh. Ellen traumatizes a poor girl by telling her how many calories are in her tube feed. There is so much wrong with this whole scene. Also in real life no one would EVER be allowed to talk about something like that in an eating disorder group therapy session. EVER. There are things called group guidelines.
  17. Did the therapist just tell a client matter-of-factly, “Now you’re thinking about how to burn it off,” in the middle of group IN FRONT OF EVERYONE?? Unspoken rule #15 for eating disorder therapists: Don’t suggest or infer the presence of ED thoughts/ behaviors in front of other people. If I learned I just gained weight at my dietitian’s office and she said, “Now you’re thinking about how to lose that weight,” I would tell her to fuck off. Then I would leave the session and never come back.
  18. No one here seems to be struggling with anything besides starving, purging, and being underweight… with the exception of the poor black girl who was probably thrown into this movie without any character context for the sake of artificially promoting diversity.
  19. At this treatment center people eat whatever they want apparently. You just need to gain weight and they don’t care how you get there?? What the actual fuck. Who cares how you get there? Everyone does!! What the hell, that’s why you’re in TREATMENT. I guess someone could binge to a normal weight (been there), but that is NOT normal.
  20. I kind of want to slap Ellen. She’s being really annoying. Not because she has an eating disorder but because her over-the-top brooding angst and smug superiority is just pissing me off.
  21. Also I’ve never seen anyone so smug and superior on day #1 of treatment. On day #1 of one of my treatment stays I was having panic attacks left and right. This is so unrealistic.
  22. For a movie that’s supposed to be about recovery and not food, there are sure a lot of food scenes in this movie….
  23. People can’t just leave the table in the middle of mealtime. Why is there no supervision for these clients??
  24. The black girl is just sitting at the table eating peanut butter. Not exactly normal eating, but she is also sitting there looking like she wants to stab everyone in the room. Same, girl, same.
  25. All they talk about is getting each other laxatives, purging, weight, and people being fat. What a waste of allocated resources. Who the fuck would pay for this IRL??
  26. KR shows up at Ellen’s bedroom at night to make a house call. What is even happening right now? What psychiatrist-turned-internist-turned makes a night house call just cuz???? My psychiatrist sees me for 15 minutes every 3 months. This is sketchy AF.
  27. This facility is everyone just feeding off of each other’s disorders. “Unconventional” is one way of putting it. Another way is super fucked up, disordered, or a facility that needs to be shut down. They are legit giving each other tips, triggering each other, and calling Emma Stone fat. How is there nobody calling them on this?
  28. KR is now a family therapist. And he’s a HORRIBLE family therapist. Like seriously awful.
  29. THERE IS SO MUCH WRONG WITH THIS FAMILY THERAPY SESSION. I literally can’t.
  30. KR lets Ellen’s family talk over each other while Ellen is sitting there looking like a romantic, tragic ghost *I take my 415th eye roll of the movie.*
  31. Kelly, the sister, is the only normal person in this entire movie besides the black girl. Actress who plays Kelly, props for showing actual emotion and having a 3D character.
  32. No one says “rexy” for anorexic. Right?? Please let’s not start saying that. I can’t take it.
  33. Ellen uses family therapy as an excuse not to eat and everyone exchanges a knowing glance. The undertone being that people with ED’s have messed up families. Playing on stereotypes again….
  34. Question: Is anyone getting medically monitored in this place? I’ve seen no blood draws, no IV’s, and these clients are acting out like crazy.
  35. Trying to scare people into eating to avoid dying is a huge part of this movie, and that just doesn’t work.
  36. The whole scene with Lucas kinda sexually trying to get Ellen to eat a chocolate bar is weirding me out. It sounds like chocolate is getting them to semi-orgasm. Has anyone who created this movie ever seen someone with an eating disorder try to eat????? It’s not like that. It may involve tears or panic attacks but certainly no orgasmic expressions of how good food tastes.
  37. Lucas is trying to force Ellen to eat, which I guess is good because no staff is ever there, and no one else seems to care she’s not eating.
  38. KR just says, “We’re never doing family therapy again. That was a shit show.” I saw that family therapy session and tbh, I think part of the shit-show nature of the family therapy has to do with the fact that KR is an AWFUL family therapist. AWFUL.
  39. KR literally just told Ellen her name seems old fashioned and that she should change it. Um WHAT??!!?? What psychiatrist/ internist/ family therapist tells a client to change her name????
  40. Ellen is Eli now. Just… whatever.
  41. Eli and Lucas pretend to have cancer and be in hospice to get free alcohol. In the meantime, Lucas tells the waitress she is chewing and spitting because of her chemo. I don’t even know what to say here… Is this supposed to be this coming of age moment that they’re out in the community and free and shit? This is a really sick way of doing that.
  42. A client mentioned her mother took her to a Holocaust museum to feel guilty about starving. That’s what you got out of seeing the Holocaust museum??
  43. KR is taking the clients to a waterfall in the dark, and they all start dancing in it. It becomes some artsy music video of dancing in a waterfall being alive. What is happening right now….
  44. Also why would a psychiatrist/ internist/ family therapist/ individual therapist would taking a bunch of teens to a waterfall in the dark alone….
  45. Is this guy still getting billed $200/ hour for dancing in a waterfall?
  46. Asking for a friend.
  47. This waterfall scene is weird as hell and I have no idea how this has to do with anything. Is the indication that waterfalls and knowing you’re alive heals eating disorders? Because that’s just not true. At all.
  48. Eli decides to eat a chocolate bar in the most eating disordered way ever by cutting it into small pieces and eating one small piece. People are giving her props though?
  49. Lucas: “Did somebody touch you as a kid or something?” That’s a great way to bring up past trauma.
  50. Lucas and Eli can’t be making out right now.
  51. Wait they’re making out right now.
  52. Are you fucking kidding me??
  53. Who falls in love in eating disorder treatment? I’m sorry, but I know a lot of people with ED’s, and that’s not really an option usually. HIGHLY unrealistic. Also Lucas is possibly in love with Eli after they’ve known each other for what, 2 days??
  54. I will say, the scene about the miscarriage is sad. Followed by the ridiculous comment by another unsupervised client, “Can you push a baby out by throwing up too hard?” Face palm.
  55. Eli keeps getting weighed in this dramatic way, and the staff is letting her see her weight. When does that ever happen in treatment? Treatment weight is almost always done facing away. I still don’t look at my weight years after my last treatment stay- it’s not something I need to know.
  56. Eli amping up her empathy about Megan’s miscarriage: “That baby was never going to make it.” Eli, stfu. For the record, at least Megan has eaten more than one bite of chocolate this entire movie.
  57. KR is now Eli’s individual therapist as well- so we have 4 disciplines going on here. Regardless of this alone being professionally irresponsible, Eli starts asking about KR’s life like all healthy therapy relationships start… and KR answers. KR says he is practically married to his work. Eli tells him, “Sounds like you’re avoiding intimacy doctor.” I just can’t right now. I think I said that earlier but I really can’t now.
  58. KR is saying some bullshit about how there is no point of life and Eli knows what to do and “stop waiting for life to be easy.” KR is the kind of therapist who gets training by watching Dr. Phil one time. He is also the kind of therapist who nobody ever sees because glib sayings and boundary-less, unethical therapy doesn’t happen in the real world.
  59. Eli runs away from treatment, ditching her friend Lucas, who says he needs her and just professed his love for her last night. To be fair, I’d run away from that treatment center too, but for different reasons.
  60. KR, being the super ethical and great doctor he is, let’s Eli run off saying, “For Eli the bottom is critical.” Tbh, for many the bottom is death. But guess he’s cool with her taking that chance?
  61. Eli ends up staying with her mom, who thinks she should feed Eli with a bottle and rock and cradle her because Eli’s mom had postpartum depression when she was born, and Eli missed out??
  62. This is hilarious, her mom is crazy.
  63. But wait, hold on, Eli wants to be fed with the bottle. The mom pulls out the baby bottle, full of rice milk.
  64. Holy shit this is happening.
  65. The camera fades out as Eli is in her mom’s arms being fed by a bottle.
  66. I feel like I’m on drugs. What is happening??
  67. Eli walks in the moonlight and starts a trippy dream sequence that I don’t understand. I guess the point of this is that Eli finally realizes she’s dying because she sees herself below the tree with all her bones sticking out. I understand this is supposed to be a formative scene in the movie, but all I can’t take it seriously. This movie is so strange. It lacks substance, depth, any semblance of professional respect, and Eli just got fed with a baby bottle. No, I’m not over that.
  68. Also the “baby feeding” thing NEVER happens. Okay, there was the Peggy Claude-Pierre book that terrified me as a freshman in college, but nobody does that anymore (I hope).
  69. What is with this movie and bones?? I know, I know you’re skinny!! I know, it’s called, “To The Bone.” I don’t know how the movie producers can realize that not everyone with anorexia has visible bones! In fact, most don’t. The constant protruding bone imagery is not only inaccurate but triggering and frustrating.
  70. Then all of a sudden Eli wakes up from the moon/ tree sequence. Eli proceeds to hug everyone in her family, and she goes back to treatment… I guess ready to get better suddenly?
  71. Wait, so last night you got fed by your mom in a baby bottle, passed out while hiking, and had a trippy dream sequence and got healed??
  72. Please don’t tell me the movie ended.
  73. The movie ended.
  74. Are you kidding me?
  75. What did I just watch for the last hour and a half?
  76. Dear God, I hope nobody thinks having an eating disorder is anything like that, or that treatment is anything like that.
  77. This movie has gotten a lot of positive press through reviews and feedback from Sundance. WHYYYYYYY??????
  78. *screams into the abyss*
  79. Breathe. It’s okay. You’re okay. People are hopefully going to realize that this is not what the normative eating disorder experience is like. Even though there are some attributes of truth, “To The Bone” has so much gross inaccuracy, as well as triggering imagery and trite, unrealistic therapeutic discourse.
  80. This is so sad. Guys, we really need to make a good movie about eating disorders.