It may seem as if the conversation about the new Netflix film “To The Bone” is the usual one: about thin young women. It’s not. Something amazing and new is happening.
The film, soon to be released, is about a young woman struggling with and surviving anorexia nervosa, one type of a range of deadly mental illnesses called eating disorders. People in the world of eating disorders awareness have mixed feelings about the project and the publicity around it. But for the first time a genuine diversity of opinions are being expressed and the glorious and genuine conversation reflects the reality of eating disorder awareness and advocacy right now. The film is about a story decades old, but the controversy is all about 2017.
We do not all agree: and that’s okay!
I am overjoyed to see a variety of voices coming out into the light about eating disorders. No longer are we just playing badminton over single issues: “nature OR nurture?” “anorexia vs bulimia” “blame society or blame parents?” “self-harm or victimhood?” “dying to be thin, or a need for control?” “biological or societal?”
The most visible critique is largely about “triggering” “glamorizing” and “stereotyping” eating disorders. But there’s more this time: there’s race, and gender, and weight stigma. There’s conversation about evidence-based treatment vs “wanting to live.” Real issues around objectifying thin bodies are not just grumbled about but are making it into the media. People with eating disorders, their parents, policy-makers, clinicians: voices are coming out and being heard. They’re disagreeing with one another. We’re collectively going on record and destigmatizing the topic.
My personal concern is a recovered eating disorder patient being subjected to an “extreme” but “supervised” weight loss regime for the filming, as the actor Lilly Collins has publicly shared. As a mother, as an eating disorder advocate, as a student of neurobiology of mental illness I can assure you this is analogous to infecting an actor with a deadly bacterial infection to let them relive their surviving a near amputation. It’s like giving heroin to a recovered addict so they can be more realistic in their portrayal of their struggle. And as far as awareness, this is like deliberately maiming an animal for a film about animal cruelty, “for the cause.”
The triggering that scares me
As a parent, as a parent advocate, I am undone at the idea of someone’s son or daughter having a “supervised” weight loss diet for a role of any kind if there was any eating disorder history. That such a thing happened for a film about eating disorders seems beyond belief. All I can guess is that the filmmakers simply don’t know enough about modern neurobiology and current practice, and that’s concerning. Because the “trigger warning” really needs to be on sanctioning weight loss diets for those predisposed to an eating disorder.
Eating disorders are disabling, often fatal brain disorders where any level of dieting can trigger a cascade of psychiatric symptoms very difficult to reverse after they are started. Anorexia nervosa recovery is infamously difficult and often unsuccessful even with the most well-meaning care. It goes without saying, I would think, that there is no such thing as safe or responsible “supervision” of deliberate weight loss for someone who has recovered. I worry for this actor. I worry for the recovered and recovering people and their families who will be misled.
We do need awareness.
What we need, urgently, is recognition that eating disorders are brain problems, not choices. We need the public to know that eating disorders, of which anorexia nervosa is the rarest and not more dangerous than the rest, can not be identified by looking at people’s bodies. We very much need awareness about effective treatment that is now saving lives in large numbers based on recent research, not patients “wanting” to be well. Cancer patients want to be well, too, but they need medicine and good healthcare, not just motivation.
We need the public to know that dieting, or simply undereating while growing up, is deadly dangerous for those who have had an eating disorder diagnosis (not just anorexia nervosa) and that the actor in this film undergoing weight loss for the film — and the publicity around that “supervised” weight loss, is going to do the kind of negative awareness that the eating disorder world least needs.
Trigger warning
I am also hearing a great deal about “triggering” of those who have struggled or may be predisposed to these mental illnesses. You may be thinking: if a film accurately portrays a terrible illness and moves people to understand and support sufferers and their families, it could be a good thing. You wonder if people are just being too fragile and that shutting down conversation just brings more stigma and secrecy. And I partly agree: although “triggering” is the “new black” of social chatter there isn’t any evidence that eating disorders, or other mental illnesses, can be caused or worsened by media attention. It is true, however, that for anyone who has been through traumatic experiences, like life-threatening illness, it is incredibly hard and most likely unhealthy to steep oneself in that experience. And for mental illness that seizes on society’s values and messages, all the more so.
The greater harm of exposure, however, strikes me as having one’s friends, family, co-workers, and strangers discussing your problems as if they were now more informed about them. For that, the movie would need to transmit accurate and helpful information. I have not seen the film, so I can not say whether it does.
But, there’s more to the dieting for a role about eating disorders. Portraying anorexia nervosa in a thin body is not accurate. Most people with this mental illness do most of their suffering in bodies that are not visibly emaciated. You can have anorexia in a larger body, just as you can suffer from binge eating disorder or bulimia nervosa in any size body. It is a myth that anorexia “looks anorexic.”
For some bracing truths, I recommend The Nine Truths endorsed by most of the eating disorder world, and even by the filmmakers of To The Bone.
Movie-making is not advocacy.
Movie-making is not advocacy. It is not the job of the producers or the actors to be medically accurate, or to be in charge of eating disorder awareness. It is up to advocates and authorities on mental illness to do that, and if not for the celebrity and public eye that Hollywood affords, I doubt many eating disorder advocates would be lauding or associating with the film. And few are. Advocates are being advocates: loud, argumentative, passionate, and not all concerned with the same problems.
I’ve seen media attention to eating disorders come and fade away over the 15 years I’ve been at it. We always, always hope for “awareness” to come out of it, and we hope that the public’s awareness is focused on our particular cause or message or organization. But in hindsight, it never is. Society is still seeing eating disorders as about thin, privileged, white women with anorexia who have bad parents and existential quests. This film won’t fix that image. It will come and go. But the advocacy world is no longer just focused on those issues, either, so my hope is that the awareness this time will remain about the range of voices and concerns, and gender and body size and diagnosis and ethnicity and perspective, and that is what lasts. Not in Hollywood, which doesn’t care, but among advocates. That is the change this particular media moment may bring.
Laura Collins Lyster-Mensh of Circum Mensam LLC is a longtime eating disorder advocate and author of Eating With Your Anorexic and Throwing Starfish Across the Sea. She serves as Outreach Director for F.E.A.S.T., the global eating disorder charity for parents and carers. She is the host of NEW PLATES podcast.