To the Bone, a film about anorexia nervosa, debuted at the 2017 Sundance Film Festival and I was fortunate to have secured a ticket. Eager though I was to see it, as a psychiatrist who has specialized in the treatment and study of eating disorders for more than 25 years, films like this make me nervous – nervous about whether or not the filmmakers will “get it right.”
I wondered whether the film would help or hurt the general public’s understanding of brain-based disorders such as anorexia nervosa and bulimia nervosa. These disorders, associated with amongst the highest rates of morbidity and mortality of all psychiatric conditions, are sometimes glorified in the media’s portrayal. I was hopeful that the writer and director’s (Marti Noxon of Buffy the Vampire Slayer fame) firsthand experience with an eating disorder would lead her to portray the recovery-is-possible message that I believe in so strongly (a message I work hard to convey to patients and families alike). But what about the “unconventional” (and Keanu Reeves handsome) doctor? Would this depiction of a clinician help or hurt patients and families sign on for effective treatments?
I am delighted to say that the film did indeed “get it right.”
The movie tells the story of Ellen (played by the exceptional Lily Collins), a young woman with severe anorexia nervosa, who, when the story begins, is hesitant to engage in treatment for her condition. It captures Ellen’s hatred of her illness together with her reluctance to let go of her symptoms. It does a terrific job of bringing to life the protagonist’s sense that she is different from all other patients, while making it clear that her symptoms are actually typical. She uses her thumb and forefinger to check out the radius of her upper arms multiple times each day, water-loads at the sink before being weighed, and develops the fine hair pattern called lanugo at a low weight. (The latter Ellen tries to ignore until her doctor asks her whether she likes the “furries.”) These characteristics are not what make her special; these are symptoms she shares with other individuals with anorexia nervosa, a fact fully recognized by the handsome physician.
As for the treatment Ellen undergoes, the movie is getting press for Ellen’s putting her trust in an “unconventional” doctor, played by Keanu Reeves. The big headline for me, however, was that this film manages to highlight elements of treatments that are the convention in successful interventions for eating disorders:
- Eating is essential in eating disorders treatment: Eating disorder patients need to eat, and that they eat sufficiently may be more important than what they eat.
- Willingness to participate in treatment is a big help: The eating plan and other aspects of structured treatment work best when accompanied by a readiness for treatment, a true willingness to give treatment a try.
- Being willing to try treatment is not the same as doing it on one’s own: An individual’s motivation for change is crucial, but needs to be paired with (often multi-modal) treatment if someone is to achieve behavioral change.
- Irreverence is allowed: Like the film’s doctor character, I find that an irreverent approach to the challenge of anorexia nervosa is often helpful. I too have asked patients to consider getting pissed off at their illness, rather than give into the cognitions that commonly accompany anorexia and bulimia nervosa.
- Eating disorders take a toll on families: While the film depicts a number of difficult family members, it also portrays the desperation experienced by family members when a loved one is plagued by a life-threatening illness. In one particularly moving scene, starving Ellen’s desperate mother prepares a baby bottle with rice milk that she ultimately feeds to Ellen. In another, Ellen’s half-sister pleads with her to “try this time,” telling Ellen that “if you die, I’ll kill you.” Families and friends find eating disorders frightening, angering, and confusing and may feel hopeless and helpless in response to the conditions their loved ones face.
I understand that To the Bone was purchased by Netflix during the Sundance Festival and will likely be commercially distributed. I look forward to its being available so that patients, families and the general public may further the discussion about these serious illnesses and the strategies that may be necessary to treat them once they develop, and to help people stay well. I’m even more eager for developments that stop these conditions in their tracks even before they take hold.