“To The Bone”- A Conversation About the Portrayal of Eating Disorders in Film – Portrayals of Mental Illness (2024)

To the Bone faced a lot of controversy for its depiction of eating disorders. The main concern of most people was that it is an irresponsible portrayal that trivializes eating disorders, plays on stereotypes, and is potentially harmful to at-risk-viewers. However, despite that cloud of negativity surrounding the movie’s content, some people said it was an honest and much needed story that accurately depicted the struggles of having an eating disorder. After watching the movie, myself, I read a collection of popular source reviews. These reviews were written by a range of authors including movie critics, members of the public, people who have dealt with eating disorders, and psychologists.

One of the prominent concerns was that the content of the movie could be triggering and/or aspirational for people who have or are at risk for eating disorders. Such content includes Ellen’s emancipated figure, calorie-counting, food-avoidance behaviors, purging, and extreme exercising. There are concerns that at-risk-individuals might see this content and imitate it. Also- evident by the fact that images of Ellen have made their way to proanna websites- some people might see her size as aspirational and want to be like her and/or think they are not ‘good enough at their eating disorder’ because they are not that thin (Leszkiewicz, Beresin and Derenne). “Some worry that perhaps those young people who do not have an eating disorder and would not have otherwise developed one may develop “copycat” behaviors to get the intense attention that is demonstrated in the film” (Beresin and Derenne). While I agree that there were detailed depictions of harmful eating disorder behaviors, I feel that it would be irresponsible to not show these realities of the disease. I believe that hiding the truth is more dangerous, and that the truth needs to be shown along with appropriate education. The movie would have been less honest if these specifics were not depicted. It is this ‘realness’ that helps paint the painful and destructive nature of eating disorders. I think removing anything that could be triggering would lead to a false and trivializing portrayal. Additionally, there are much easier ways to find images of very skinny females, learn about calories content, or be exposed to food-avoidance behaviors. For someone who is looking for this information, finding it is as simple as a Google search. Beresin and Derenne say “As for concerns about Ellen’s story serving as a “how to” manual or guide to weight loss behaviors, the truth is that much more explicit and detrimental information can be easily found online if someone is actively looking for it.” With the wide access to this potentially harmful content, exposure to some degree seems inevitable. It is, therefore, my belief that such potentially harmful content should not be avoided, but rather, brought to light in a context that is truthful and can be used to start a conversation and educate people. “If we as a society can no longer talk about serious issues out of fear they may trigger someone to harm themselves, then we’ve managed to harm everyone” (Lawrence). I think it is important to note that if someone is going to be triggered by the content of the movie to the point of actively engaging in unhealthy behaviors, then there are other factors playing a role.

A further criticism made is that it was inappropriate for the actor who played Ellen to lose weight to the point of being underweight for the role. This is especially troubling given that the actor struggled herself with an eating disorder in the past (Leszkiewicz). I can see why the producers had her loss weight. It made the movie seem more realistic. Additionally, her emancipated body was portrayed as unhealthy and scary, not beautiful and aspirational, and her image showed how deadly eating disorders can be. The fact the Ellen looked so skinny and still saw herself as fat, also, brought light to body dysmorphia and the difficulty some people have with seeing how sick they really are. Despite these possible artistic and awareness benefits of the actor being very skinny, however, I believe that it was dangerous and inappropriate for her to lose weight.

Another issue with the movie that was brought up in the article written by the two psychologists, Beresin and Derenne, was Dr. Beckham’s unconventional treatment style. At the residential center, the patients were allowed to eat whatever they wanted- expected, however, to work towards healthier choices and gain weight to stay at the facility. They also had concerns with comments Dr. Beckham made, particularly, “I am not going to treat you if you’re not interested in living.” They saw this as substandard care bordering malpractice. I agree that the residential center was strange and not an accurate representation of most treatment centers. With ethical and safety concerns and practical medical and insurance standards, it would never be the case that patients were allowed to choose to eat or not. This depiction also failed to address the emotional and physical pain of force feeding and weight secrecy that is characteristic of most, if not all, inpatient treatment centers. I do think, however, that this treatment style was a thought-provoking concept. I think that eating disorder treatment would benefit from finding a way to be less restrictive and controlling while still maintaining the safety of patients. It is important for patients to feel in control of their own recovery and be able to learn for themselves what behaviors are their own and what is the disorder. In terms of Dr. Beckham’s comment, I agree that it seems harsh and could be harmful to some vulnerable patients, but in the context it was helpful. A problem in treatment is always picking patients up, carrying them, and letting them become comfortable in being sick. Treatment has the potential of being an addiction itself or a form a self-punishment. I think that if the patient is not invested in getting better, then treatment will not be successful. This is not to say that the person cannot struggle and be ambivalent, but there has to be at least some underlying desire to live. I think Ellen needed to hear that. Whereas eating disorders are not a choice, recovery is one and it is important for a patient to be given the opportunity to make that choice. Of course, there are countless legal and ethical issues that arise when someone is seriously ill and/or a danger to them self or others and they are resistant to treatment. These are issues that need to be discussed in the medical field with the goal of finding moderate solutions that allow for autonomy and ensure the greatest level of safety possible.

Leszkiewicz voices issue with the idea of hitting bottom discussed in the movie. Dr. Beckham believes that Ellen needs to hit bottom before she will fully accept treatment and the idea of recovery. He says,

“The problem with treatment, for some of these kids, is that we won’t let them hit bottom. It’s too hard to watch. But for Eli, the bottom’s critical.”

Leszkiewicz believes that this suggests that “Ellen’s eating disorder isn’t life-threatening unless she is the thinnest she can possibly be without dying.” She has issue with Ellen being as skinny as she is and not being considered at bottom, because this might give people the idea that they are not sick enough unless they are as skinny as possible. I do not think this suggestion is made. Dr. Beckham clearly states that Ellen will die if she does not make changes soon. I also don’t think that the idea of bottom is being the sickest possible. It is not defined by how underweight a person it or how much their life is in immediate danger. I believe that the bottom is hitting a certain mindset. It is coming to terms with mortality and making the decision to live. It is picking oneself up rather than being picked up by someone else. However, I think the depiction of Ellen hitting rock bottom and having a sort of epiphany was dramatized and unrealistic. People don’t actually have huge turning points this this. It is slow progress with steps backwards and forwards. It is constantly remaining yourself what you really want. It is hard work for the rest of your life.

Beresin and Derenne also claim that the movie “fails to capture the loneliness and isolation experienced by individuals with eating disorders. The relative ease with which the characters connect with each other, are open about their struggles, and are willing to be confrontational is unusual for individuals with eating disorders. A budding romance between two patients with anorexia nervosa in the first weeks of treatment is difficult to fathom, as most young women with anorexia nervosa are wary at best about intimate relationships.” Though it is true that eating disorders are often shrouded in isolation and loneliness, I do not find it strange that these characters were so open. People with eating disorders are so lonely and misunderstood that when they are able to connect with people who understand what they are going through, it is almost addictive. Everything that was bottled up just comes spilling out. Pair this will finally feeding one’s brain and body, and patients often experience an abrupt and fleeting euphoria similar to a drug high. Luke says this well when he tells Ellen,

“I have been running on empty for so long now that when I eat, I get this crazy burst of energy.”

I would agree, though, that the romance was out of place. I think it was done for cinematic and entertainment purposes. It is true that intimate relationships are terrifying for people who hate themselves so much. On the other hand, however, I do see how the feeling of finally connecting with someone can take a person over. This is shown by Luke’s reaction to learning that he will never dance again. He tells Ellen that she is his new thing, bringing out his need to have something to define himself by.

Freeman finds no redeeming qualities in To the Bone. She says that it glamorizes anorexia and reduces it to an aesthetic expression by the why Ellen dresses, applies her makeup, and always looks “Instagram ready.” She says that this depiction “sexes up” the illness, and this is only made worse by the unrealistic romance between Ellen and Luke. Additionally, the movie over focuses on the physical manifestations of anorexia and doesn’t show the inner struggles. When Freeman looks back at treatment for her own eating disorder she doesn’t think of the food or how much she weighed. She thinks about the cold, isolation, and institutionalization. I agree that the movie was somewhat superficial, and Ellen’s outfits and romance were a little much. Additionally, some of the conversations about food and weight stopped short, and the reasons the patients felt certain ways were not addressed. I found the comments and hidden conversation about calories, being fat, purging, and so on were realistic. These conversations do happen, and it is easy to get caught up in these superficial worries. I wish that the movie addressed the feelings behind these anxieties a little bit more. However, I don’t think the movie failed to show any of the inner turmoil of eating disorders. Ellen is clearly struggling. She compulsively checks the size of her upper arms and does sit ups until back is bruised- two common and consuming obsessions of people with anorexia. She blames herself for the death of a girl who claimed to kill herself because of a drawing Ellen posted on Tumblr. She wants to connect with her sister but is so caught up in her illness that she cannot. Though this is only skimming the surface of all the struggles people with eating disorders face, I think it is a fair and accurate representation to start a conversation.

O’Hara writes about how “To the Bone” does not glamorize anorexia. She writes,

“On-screen portrayal of anorexia have peddled the myth that it’s simply about young girls wanting to look a certain way. But when you see the whole of To the Bone, it becomes crystal clear that the filmmakers know all about these pitfalls and are trying very hard to do something else.”

See Also

To The Bone: A Review

In the first scene, Ellen rejects the idea that eating disorders are about media portrayals and social pressure. In response to a girl complaining about the media’s depiction of the sad, fat girl, Ellen sarcastically replies, “Ugh, society’s to blame, the world is so unfair, I have to die.” Whereas Leszkiewicz sees this as an inappropriate and dismissive quote, O’Hara sees it as a way to show that eating disorders are not just about wanting to be skinny. O’Hara also states that the calories talk that some people fear is triggering and inappropriate, is a truthful depiction of a real eating disorder behavior that is appropriately addressed in the movie as it is followed by instructions to not discuss numbers and to focus on the underlying emotions. I agree with this but wish it was taken a step further and those emotions were discussed more. Additionally, treatment is not shown as glamorous. “There are jutting bones and hidden stashes of vomit; they’re subject to strict house rules that deny them privacy in order to keep them from self-harm.” I agree with this. There was also a scene showing weigh-ins which is traumatizing to anyone struggling with an eating disorder. I think this scene depicted the inner turmoil well with one character who wanted to gain weight because she was pregnant and wanted to be healthy for her baby, but she was also terrified. When she saw that she had gained weight she cried- relieved, mad, and scared at the same time. This character later has a miscarriage showing a sad and detrimental reality of eating disorders and the physical effects. In terms of the dark humor in the movie, O’Hara believes that it does not make light of eating disorders and it comes from a place of knowledge. Though I think some of the humor could have been taken in an offensive way, it did serve a purpose and helped with the depiction of some serious issues without being overly heavy. It is also not uncommon for people who are struggling, especially when they are in close quarters with other people going through the same thing, to make dark jokes. Though such is not healthy, it is a common coping mechanism, and one that I think should be addressed rather than denied.

The director of the movie, Noxon, and the actress who played Ellen, Collins, say their intent was to give a realistic portrayal of eating disorders while still creating an entertaining film (Leszkiewicz). The movie is actually roughly based on real-life experience of both Noxon and Collins. In response to criticisms that only anorexia is depicted and in some stereotypical ways, Collins responses that the movie only shows one story. One person’s reality with an eating disorder differs in many ways from everyone else’s. “Ellen’s experience is not meant to represent the experiences of all people who have suffered from an eating disorder” (Lauf). Noxon, herself says,

“It’s important to remember that each person’s battler with EDs is unique and To the Bone“is just one of the millions of ED stories that could be told in the US at this very moment.”

Also, I believe that maybe there is a reason so many stereotypes are depicted, especially those that are glamorized. It shows that these ‘thinspo’ stereotypes can be fulfilled and not make you happy. Ellen is clearly miserable and sick. It shows that these attributes are not desirable rather than the other way around. Beresin and Derenne agree that Ellen is depicted as sick and unhappy. “She is not attaining the normal developmental milestones for someone her age, she lacks fulfilling intimate relationships, and she feels terrible about stressing her family. While she is struggling with the consequences of her illness, she is having trouble making the necessary changes to recover. It is hard to view this depiction of her life as “glamorous.” They do note, however, that Ellen is “Hollywood beautiful” with her baggy long sweaters and flawless eye makeup. They wish that the message was clearer that eating disorders are serious, deadly illness. I both agree and disagree with this view. I think Ellen was very “done up” in terms of her clothing and makeup. I don’t think this was a widely inaccurate depiction though. Many people who suffer from eating disorders, especially anorexia, are perfectionists, and this can come out in one’s appearance. This is certainly not the case for all people with anorexia, but it is also not uncommon. Ellen might be hiding her real disgust with herself behind this facade of a perfect appearance.

A part of the movie that I think was done really well is the relationships between Ellen and her sister. It seems to be the only truly genuine relationship Ellen has. In one scene Ellen’s family comes to the house for a therapy session. When Dr. Beckham asks Elle’s sister how she feels, she replies that she doesn’t understand why Ellen can’t just eat. She also says that she looks back on the experiences in her life and remembers, “That is when Ellen was in the hospital. That is when Ellen fainted on the bus.” She says that she just wants to have a sister and she doesn’t want her to die. I think this is a powerful portrayal of how eating disorders impact family members. Eating disorders thrive on disconnection and isolation. The person suffering from the illness is never the only victim. Also, during this scene, Ellen says that the turmoil in her family is her fault. To this, Dr. Beckham said to forget blame. It has no place in healing. This scene did a great job at showing the negative impacts of Ellen’s illness on her family while also making the important point that she is not to blame. Another relationship that I think is depicted well is the one between Ellen and her mother. In one of the ending scenes, Ellen’s mother tells her that if death is what Ellen wants then she accepts it. She just can’t keep fighting her. This is heart wrenching and may seem to give the message that death is an acceptable option, however, I think the honesty shines light on a reality that people are scared to talk about. Overall, this scene was strange. Ellen’s mother ends up bottle feeding her. But is shows the desperation that comes from fighting this disease, and the place some people must go to just to cling onto life.

A consensus made by all authors I read was that it is difficult to write films and movies about mental illness, and the line of what is appropriate and what is not is blurry. It is hard to show the reality of these illnesses, and be truthful to them, without being potentially triggering. Trying to censor this material can just stigmatize mental illness further. Leszkiewicz writes, “As with 13 Reasons Why and its depiction of teen suicide, it’s difficult to talk about potentially dangerous portrayals of mental illness without sensationalizing them. TV can’t cause depression or anorexia or any other mental health issue. And if predominantly young and teenage audiences are effusively relating to a programme about mental health, it feels both patronizing and naïve to insist that these shows are unsafe for the people they’re made for.” Bethany Rose Lamont, an author who writes about mental illness agrees with this and states, “It’s simply too reductive and encourages a sense of moral panic that does not support those struggling.” Holmes also speaks to the fact that images cannot cause eating disorders, and that painting them in this light is not only false and overly simplistic, but harmful. She says,

“Debates such as those over To the Bone perpetuate the idea that girls can be “infected” with anorexia by looking at images of very slim (or starved) bodies – and that this is where the crux of anorexia lies… Not only do such ideas massively simplify the complex reasons why anorexia may develop, they also trivialize it.”

None of these authors ultimately, believe that To the Bone is a good representation of eating disorders. For example, Homes wishes the film challenged the stereotypical portrayal of someone with anorexia and “expand[ed] our understanding of what eating disorders are in terms of social and cultural identity, and how they might address the stigmatization and trivialization of eating disorders and improve treatment.” However, they acknowledge and address the difficulty with depicting mental illness, the falsehood that media can cause mental illness, and the question of to what extent such content should be censored.

Beresin and Derenne say that although they disagreed with the depiction of mental health treatment in the movie, they think some important messages where given. Ellen points out that people with eating disorders are people, not problems. The movie also shows that recovery from eating disorders is possible. Ultimately, they suggest that parents watch this movie with their children and teens and have an open conversation about the content. They also encourage schools to use this movie to talk about eating disorders and body image. They do not support censoring or prohibiting the viewing of the movie. I think this is a very good idea and uses the film for educational purposes and to help start important conversations and put harmful stereotypes out on the table. “When supplemented by trustworthy material curated by adults who are experienced with the trajectory of eating disorders, the film may be used as a springboard to discuss the nature, course, and treatment of eating disorders” (Beresin and Derenne). O’Hara says that it might be helpful for people who are struggling to see themselves reflected on screen, and for friends and family to gain a better understanding of what a loved one is going through.

My impression is that To the Bone has flaws. It is certainly a Hollywood depiction and has some unrealistic content for the purpose of being entertaining and give feel-good moments. I think that such parts of the movie are the over-the-top dramatization of Ellen’s family issues, the romance between Ellen and Luke, and the feel-good epiphanic ending. Also, the movie could be triggering and harmful to a vulnerable audience. Lastly, some of the struggles are painted in a superficial light, focusing on calories, weight, and size, and neglecting the deeper turmoil with self-worth. However, overall, it has the potential to help spread awareness, improve understanding of eating disorders, and provide a platform for open conversation regarding these serious illness when viewed in a supportive and educational environment. There is honest and raw dialogue that cuts to the core of one’s struggles. The movie is also not afraid to show the real and non-glamorize behaviors of someone with an eating disorder, and it drives home the point the eating disorders kill. Thirdly, it makes the important point that eating disorders are not about food and that a person with an eating disorder is not an illness. Also, I think that it is not only the honest and realistic depictions and dialogue in this movie that can serve as an educational tool, but also the stereotypical and overdramatized content because such can bring those stereotypes into the light and start a conversation as to why some portrayals are inappropriate. Of course, this necessitates that the movie is viewed in an environment where such healthy and productive conversations can be had, and stereotypes can be countered. To the Bone is not great. It is not some groundbreaking depiction of eating disorders that will suddenly shine light on all the misconceptions. However, it should not be thrown away or demonized for superficial reasons. The purpose of the movie is to start a conversation so let’s have a conversation.

Works Cited

Beresin, E & Derenne, J. (2017). Two Psychiatrists Weigh in on Netflix’s ‘To the Bone’ A missed opportunity to understand anorexia nervosa. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/inside-out-outside-in/201707/two-psychiatrists-weigh-in-netflix-s-the-bone

Freeman, H. (2017) To the Bone Confirms There Are (Almost) No Good Movies about Anorexia. The Guardian. Retrieved from www.theguardian.com/film/2017/jul/12/to-the-bone-confirms-there-are-almost-no-good-movies-about-anorexia.

Lauf, J. (2017). Is ‘To the Bone’ A True Story? The Netflix Movie Draws On The Life Of Its Director. Bustle. Retrieved from www.bustle.com/p/is-to-the-bone-a-true-story-the-netflix-movie-draws-on-the-life-of-its-director-68618.

Lawrence, C. (2017). Netflix’s ‘To the Bone’ Depicts, Doesn’t Glamorize, Eating Disorders. Las Vegas Review Journal. Retrieved from www.reviewjournal.com/entertainment/entertainment-columns/christopher-lawrence/netflixs-to-the-bone-depicts-doesnt-glamorize-eating-disorder/?returnUrl=https://www.revie.

Leszkiewicz, A. (2017). Don’t watch Netflix’s To The Bone. NewStatesmanAmerica. Retrieved from www.newstatesman.com/culture/film/2017/07/to-the-bone-netflix-review-glamourises-anorexia-eating-disorders.

O’Hara, H. (2017). Why ‘To the Bone’ Does Not Glamourise Anorexia. Grazia. Retrieved from graziadaily.co.uk/celebrity/news/bone-glamourise-anorexia/.