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Content warning: the following article discusses eating disorders and suicide.

Eating disorders have the highest mortality rate of any mental illness and, according to the National Eating Disorders Association (NEDA), someone dies every hour from one in the States. What’s more, around 20 million women and 10 million men currently suffer from an eating disorder in the US, so even if you’ve personally never struggled with one, the chances that someone you know could be suffering from an eating disorder are pretty high.

It doesn’t matter how clever or logical you are: sometimes, being thin is The Most Important Thing and it comes at the sinister price of a lifestyle which has you checking the refrigerator multiple times a day to see what ingredients your flatmate will be using in his cooking, and how many hours you’ll have to run on the treadmill tomorrow. Even for the most cynical and self-aware among us, eating disorders too often slip through the net; you’re stuck with a circular obsession you never wanted.

Anorexia is not a life experience. It doesn’t show you what really matters or teach you how to love. It isn’t romantic, and it isn’t something that can be cured by the love of a good man. Exactly because it’s such a hard subject to understand – let alone portray for broad audiences – some tact is needed: What we show young, impressionable audiences matters.

To the Bone

And that’s partly why Sundance Film Festival hit To the Bone has not had an easy road to release. The Netflix film, which made its debut on July 14, took many years to secure financing, despite writer-director Marti Noxon having been known throughout the industry.

Her new tragedy-porno, which has been compared to 13 Reasons Why, tells the tale of young anorexic artist, Ellen (Lily Collins), who spent the better part of her teenage years being shepherded through various recovery programs, only to find herself still with the eating disorder at the age of twenty. Determined to find a solution, her dysfunctional family agrees to send her to a group home for youths, which is led by Dr. Beckham, an unconventional doctor played by a very uncomplicated Keanu Reeves.

Much of the film takes place in the group home for the “rexies” where Ellen and token love interest kooky Luke (Alex Sharp) live out their emo fantasies, to the silent rage of anyone who’s ever even heard the words “western privilege” uttered. Instead of approaching the topic in a solemn and meaningful way, To the Bone tries to lighten the mood. There are aspects of this approach that are refreshing: By showing that it’s still possible to find some bleak humor in this situation, it reminds us that anorexia is something that happens to real people.

Careful Handling

Netflix

What’s more, to the film’s credit, To the Bone gets into the gritty by showing that eating disorders aren’t lifestyle choices, or even about vanity. Ellen continually tries to reassure everyone that she has her disorder “under control.” It’s a classic ano trope, capturing the crux of living with an eating disorder – we con ourselves into thinking that we’re all good, and that we’re in the driving seat. In reality, there’s nothing controlled or empowering about enacting something so antithetical to life.

To the Bone also reveals, somewhat realistically, how taxing eating disorders can be on those around us. Everyone else – from Ellen’s stepmother and half-sister, to her biological mother – is rooting for her recovery; their despair is as tragic as it is evident. If nothing else, To the Bone portrays the impact that one person’s illness can have upon their wider family and the corresponding upset.

Thankfully, it also doesn’t give straightforward, cop-out answers to the “Why can’t Ellen just eat?” question that’s on everyone’s lips. Is it because of her unconventional family situation? Her absent father? Or because Ellen just wants to be cradled and fed like a little child again? We never really find out, and the film’s narrative mirrors the realness of the situation: Often there isn’t one defining reason for why somebody turns to anorexia.

Triggering Relapses

Netflix

But while some of the handing of the film’s subject matter is done with tact, some critics are worried that To the Bone could cause relapses for recovering anorexics – not just because of the skinny bodies in the film, but by showing the kind of life where the characters are looked after by their loved ones.

Dr. Melissa Nishawala, the clinical director of the Eating Disorders Service at NYU Langone’s Child Study Center says that it might not be possible for filmmakers and documentarians to portray anorexia in a way that avoids triggering vulnerable viewers:

Because individuals struggling with anorexia nervosa often have an extreme drive to the superlative – to be the best student, to feel the most valued, and to become the thinnest – any film depicting anorexia nervosa risks igniting the quest towards starvation.

When the trailer for To the Bone was released, it prompted a flood of critics noting that the film appeared to contain many images and scenes that could be triggering to recovering anorexics. Inspired by Noxon’s own experiences with anorexia, the film can’t dodge the fact that any truthful depiction of anorexia will, by its nature, trigger those who struggle with the disease.

But, for someone in the grip of the illness, potential triggers are everywhere, and it’s impossible to guard against them all. As a society, we are collectively obsessed with thinness – and, sadly, there are no triggers in To The Bone that sufferers won’t be able to find elsewhere…

So the question becomes whether or not the usefulness of recovery narratives is worth the damage done in feeding a cultural curiosity that’s deeply unhealthy…

Glamorizing the Illness

Netflix

Audiences are worried about copycat behavior, given Noxon’s choice of protagonist and the film’s slightly-too-palatable handling of the subject matter. It’s entirely possible to believe that young audiences might extract a more glamorous depiction of the illness than what suffering from anorexia actually looks like. Ellen is confident, privileged, and beautiful – and throughout the movie there’s nothing really disturbing or disgusting enough to hammer home the horrific magnitude of her illness.

13 Reasons Why was controversial in its own way and accused of glorifying teen suicide, but the death scene that showed Hannah Parker slit her wrists in a bathtub was graphic and repulsive, its body horror element comparable to something from a David Cronenberg film. To the Bone, by contrast, doesn’t show graphic or repulsive imagery and instead trades shocking visualizations for surreal dance sequences set to inspirational music, like something from your high school drama class.

It also makes it look relatively easy for someone with an eating disorder to recover from it. At the end of the film, Ellen has some kind of vision of her own emaciated body lying in the foetal position (hair perfectly coiffed, nonetheless) and from that decides that she’s finally over anorexia. We can only hope that the rest of the movie is enough for people to realize that, even after you don’t want to live with an eating disorder anymore, it’s not all plain sailing.

The problem is that anorexia is a serious mental illness, not a phase of adolescence. You don’t just snap out of it when you reach a certain age, despite the majority of depictions in pop culture showing predominantly teens or early 20-somethings. The majority of eating disorders manifest in adulthood, with 13% of women in the States over the age of 50 currently currently suffering from an eating disorder.

Society

Netflix

Perhaps the film’s biggest failing, however, is that it doesn’t dig deep enough into the psychological complexities of anorexia. It doesn’t get inside Ellen’s head; the movie instead focuses on the budding relationship between herself and Luke. Neither does it attempt to answer why women like Ellen so frequently turn their unhappiness in on themselves.

We’ve all seen it before – female celebrities are routinely scrutinized for how they look shortly after giving birth. According to a review by Sheila O’Malley on rogerebert.com, even from a young age this type of scrutiny can engrain ideas of how women are supposed to look. To investigate a topic like anorexia using a film like this, the wider implications of how we are taught to view body weight should also be taken into account. The vast majority of us have grown up and still live in a world with a hyper-focus with how women look and are constantly defining what the ‘how’ actually is. And, according to O’Malley, eating disorders are not simply mental illnesses, but rather a greater problem of our society as a whole.

We live in a world where anorexia is “bad”, yet equally obsessive “clean eating” disorders – as propagated by food bloggers and Instagram sponsors – are recognized as healthy and desirable. If you’re obsessed with any way of eating, whether that’s clean food or Burger King for breakfast, lunch and dinner, then it’s quite likely that you have an unhealthy relationship with food at best.

In fact, mental health experts are warning of the risks of the increasingly popular “clean eating” trends, which is leaving a growing number of teenagers very thin and at risk of dying when taken to extremes. NEDA has described it as a “fixation with righteous eating.

So, really, anything with a potentially negative impact on certain vulnerable young people should be taken with a pinch of salt – whether that’s the boney, Bliss Ball ladies of Instagram propagating their kale smoothies for vulnerable and underdeveloped young girls, or films that represent young women with anorexia without also unearthing some of society’s contribution to the illness.

If the only justification for making a film about anorexia is that it provides some insight into the illness, with careful handling for impressionable young audiences, then To the Bone is a flop. At best it’s half-baked at showing the complexities of living with a serious mental illness and, at worst, it’s going to do more damage than good.

If you or someone you know are suffering from an eating disorder, you can call NEDA to seek help.

If you have been dealing with suicidal thoughts, you can call The Lifeline to speak with someone and seek help.

Correction, August 14, 2017: It came to our attention that a paragraph in this article closely resembled the wording in a similar review on RogerEbert.com. This article has since been edited with proper attribution. We apologize for the oversight.

  • Lead Image: Netflix
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