In “To The Bone”, Ellen, the main character played by Lily Collins, shifts to embrace healing when she faces and accepts the complexities of past missteps, multi-dimensional relationships, the life threatening illness of anorexia nervosa and the difficult recovery journey ahead. As Pema Chodron says… suffering begins to dissolve when we can question the belief or the hope that there’s anywhere to hide.¹
In this way, “To The Bone” presents a moving, powerful story of the soul level fight of confronting a mental illness that is so strong it has the power to take a life. It illuminates the truth. There are many small moments that lead to the onset of illness, to relapse or to transformation. The film also highlights that eating disorders are not disorders of vanity and that families who are usually well intentioned are devastated when a member is this ill. Families need to hear this because they, so often, blame themselves. Finally, I appreciate the filmmakers’ attempt to raise awareness in a non-stigmatizing narrative.
In two important areas though, I feel compelled to extend the film’s messaging. Most experts agree that anyone who has recovered from an eating disorder is advised against dieting. Lily Collins, who is open about her own history of an eating disorder, had to lose weight for the role. Hopefully, she had a great clinical team and stayed well. But for others in recovery, dieting should not be an option. Weight loss alone—for those with the underlying genetics and personality traits—can trigger a return of the illness.
“Dieting is very risky and giving it up fully is usually part of a sound relapse prevention plan.”
Additionally, Ellen’s psychiatrist provides the clinical stance that she must hit rock bottom and find her own motivation before recovery is possible. I wholeheartedly disagree. When the brain has been deprived of nutrition for a long period of time, thinking is often impaired and decision-making compromised. And even in the best case scenario when a client desperately wants life to feel better and proceed positively, eating enough can be too anxiety provoking and aversive to approach. Food is the medicine for starvation. As nutritional refeeding takes place, the food itself starts a healing process in the body and mind.
No one should wait for 100% motivation. No one should wait for a loved one to be completely ready to get better. We know that early intervention leads to best outcomes.² Starting recovery takes a leap of faith and trust in professionals. In all age groups, loved ones are often the catalyst for change and remain key participants in the process. For children and adolescents, families are important in supporting their children and are critical change agents in the recovery process. In best practices, parents even take a central role in managing and disrupting eating disorder symptoms.³ I am grateful for “To The Bone” taking on this important mental illness. It is up to all of us to continue the dialogue.
*Please note: If you have an eating disorder or if you are in the early stages of recovery, “To The Bone” can be triggering due to the film’s specificity around eating disorder symptoms.
References
[1] Chodron, Pema (1997). When Things Fall Apart: Heart Advice for Difficult Times. Shambhala Publications, Boulder, Co.
[2] Treasure, J and Russel G (2011). The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. British Journal of Psychiatry; Jul;199(1):5-7. doi: 10.1192/bjp.bp.110.087585.
[3] Lock, J and Forsberg, S (2015). Family-based Treatment of Child and Adolescent Eating Disorders. Child Adolescent Psychiatry Clin N Am; Jul;24(3):617-29. doi: 10.1016/j.chc.2015.02.012.
