‘To the Bone’ Movie: Adding Insult to Injury

I recently watched the Netflix movie that has created a lot of “buzz” with many of us working to help people with an eating disorder.

The movie did a good job portraying the condition of anorexia nervosa in a way that kept the viewers’ attention, and even elicited a few smiles despite the seriousness of the subject. It also clearly mentioned several times the awful consequences that all too often can happen when patients resist treatment.

However, though realistic in its portrayal of the condition itself, I was struck by the failure of the movie to show an understanding of effective treatment for eating disorders in general, and for showing bulimia nervosa and binge eating disorder as bit players in the tragedy. In actuality, more people suffer with bulimia and binge eating disorder, while anorexia nervosa is less common. The movie focused mainly on the condition, and only superficially and unrealistically portrayed the treatment which presumably led to a path of recovery.

The movie portrayed the highly dysfunctional, even toxic, family of Ellen, the protagonist, implying the family dynamics were the cause of the problem. It is true that people with eating disorders often do come from polarized families in which there is a father who is controlling and authoritarian, and a mother who is passive and somewhat childlike, or perhaps narcissistic and neglectful. Conversely, sometimes the mother is both controlling and enmeshed with the daughter, and the father is a fleeting apparition, orbiting well outside the family circle. However, it is simplistic to imply that the family dynamics alone cause the illness.

Ellen’s family certainly followed those stereotypical dynamics. Her biological mother seemed somewhat helpless and childlike, falling apart and needing to be parented herself, with her new partner portraying the more dominant and stable presence in the couple-ship.

Susan, Ellen’s step-mother, occupied the role of mother and father in Ellen’s home. Although it seemed she was well-meaning and did care about Ellen, she was often controlling, critical, and frustrated with Ellen’s illness. It was she who finagled a way for Ellen to be accepted into the highly sought-after treatment program after Ellen had been booted from other programs. All of this was believable since often it is one parent who tries so hard to “make” the child well while acting as a stand-in for the absent parent.

Though he was often referenced, Ellen’s father wasn’t seen in person at all in the entire movie, which did not go unnoticed by both Ellen and her half-sister, and clearly was resented by both girls. The story’s implication was that Ellen was acting out in response to her father’s neglect, and her biological mother’s abandonment. In real life though, it is never just that simple. Eating disorders are a bio-psychosocial illness and many factors come together to create a perfect storm made manifest in the illness.

Ironically, Threshold (the treatment program) seemed to parallel the family dynamics. Keanu Reeves was portrayed as a workaholic physician who avoided intimacy by his own admission, rarely making a meaningful appearance in Ellen’s therapeutic treatment, yet appearing as the be-all-end-all super doc.

In keeping with the parallel theme, the female group therapist and the live-in Mental Health Worker provided the most consistency and support for the patients.

As is often the case in real life, Ellen’s sister, and her peer in treatment, Luke, were the most supportive characters in the movie. However, in treatment, Luke and Ellen were permitted to pair-up which caused difficulties for the other patients, and would never be allowed to happen in a properly run treatment program.

To someone who has devoted a lifetime to treating eating disorders, the movie was frustrating to watch. While the movie portrayed common behaviors and symptoms of advanced anorexia nervosa and implied just how or perhaps why neglected, gifted, and/or perfectionistic young people could develop an eating disorder, the therapy was simplistic, nearly non-existent. The treatment center setting was a re-creation of Ellen’s original familial situation. In addition, the lack of structured meals mimicked Ellen’s family meals including allowing other members to fill in as food-cops. We saw polarization, splitting, parentification, and unstructured meals, none of which leads to recovery.

Treatment of anorexia nervosa involves a structured approach, with therapeutic support rather than parentification. Recovery is possible, and it doesn’t necessarily have to happen after the sufferer hits rock bottom or has an out of body experience that allows him/or her to see just how close to death he or she may be.

At EDTC, we individualize treatment with a comprehensive program of therapy and nutritional rehabilitation to enable our clients to change and thrive in a safe, warm, and healthy environment – which is what everyone deserves on the journey to recovery.

Holly Finlay, Founder/Clinical Director EDTC

For more information contact EDTC 505-266-6121

2017-09-18T13:52:20+00:00