To The Bone: An Honest Review

I don't usually write reviews, but I feel that Netflix' new addition To The Bone has been causing a stir among the mental health community, especially the eating disorder community. Having watched it last night I wanted to share my views because I know people apprehensive about watching it will want to know as much as they can without actually watching. There may be spoilers ahead!!

Summary

Ellen is a 20 year old artist and drop-out college student who lives with her father, stepmother and stepsister. With a largely absent father and a history of inpatient stays and struggles with anorexia, Ellen is convinced by her stepmother and stepsister to see a specialist, Dr William Beckham. He agrees to treat her on certain conditions, including a minimum of 6 weeks as an inpatient. Once she arrives at the house with 6 other patients, including 1 male patient Luke, she makes some progress but struggles greatly as success at the programme requires an existing wish and commitment to recover. After becoming close with Luke but being freaked out by his desire for further intimacy and the pregnant patient Megan having a miscarriage, Ellen (who by this point has changed her name to Eli) decides to run away, despite pleads from Luke to stay.

She then leaves for Phoenix where her mother lives with her girlfriend. That evening her mother admits her guilt and apologies over Ellen's anorexia, and a beautiful-to-watch moment happens where her mother actually feeds her with a bottle to show her the love she wished she'd given to her as a child. Following that evening Ellen goes for a walk, collapses from her illness and has a dream/hallucination sequence (is she dying?) where Luke tells her to come out of the sun and have a talk. He tells her how dazzling she is and they have a nice conversation. When she wakes up she decides to enrol back onto the inpatient programme with Dr Beckham and we see her last hugs with her stepmother and sister as she walks into the centre looking hopeful and ready to recover.

The controversy:

1. UK eating disorder charity Beat released a statement about To The Bone yesterday, stating that they are disappointed that Ellen's family were shown to be the main cause of her eating disorder. As they said: 'eating disorders are complex with no one single cause'.
2. In the same statement, Beat warned that 'There's a strong likelihood that people who have been affected by eating disorders would find the film highly distressing or triggering' due to talk of calories, weight, behaviours and images of Ellen at a low weight.
3.  One line of controversy comes from this article by the Guardian. One of their issues comes from the lack of demographic representation: 'All the anorexia patients, with one male exception, are young, attractive, middle-class white women, when the illness affects a far broader demographic'.
4. Another issue comes from the same article regarding Dr Beckham who describes his methods as unconventional. On this, the article writes that 'they're not: they rely on therapy and healthy eating, as almost all eating-disorder treatments do'.
   
5. Ellen's relations to Dr Beckham and also fellow patient Luke are brought into the spotlight of many articles which imply that the two males are her knights in shining armour. As the same article from the Guardian writes: 'The idea that all these hysterical female anorexia patients need is a couple of calm men to save them from themselves is, to put it mildly, grating'
6. There are also concerns about the depiction of anorexia, as Ellen wears thick eyeliner. Hadley Freeman writes from her own experiences that 'anorexia is not all thigh gaps and eyeliner', but rather hair falling out, coldness and bleeding knuckles due to dry skin.

My point of view:

I disagree with a lot of the controversial points above. For example:

1. Beat's view that Ellen's anorexia is shown to have one single cause: her family. It is true that her family dynamics play a huge part in the movie, but she also has a conversation with Luke where she describes entering puberty: 'The second you get boobs, it's like open season'. This NHS page describes one of the causes of anorexia as the 'hormonal changes and feelings of stress, anxiety and low self-esteem during puberty', as well as sexual abuse. What Ellen experienced with boys nipple-pinching her during puberty sounds like it would have caused some stress, anxiety and may have been a form of sexual abuse, whether intended or not.
2. The lack of demographic issue discussed by The Guardian may well be right, but to be surrounded by white, middle-class women in an inpatient facility is definitely not unusual, at least according to my experience. Sadly, in cultures and genders where eating disorders are less common it is less common to ask for help, linking to why they might not be seen where Ellen is (especially as this appears to be a private facility where people would be paying or covered by insurance for help). So it may not be demographically correct but it is probably reality.
3. In my view, Dr Beckham's methods are unconventional. To have choice over how much you eat in inpatient is very unusual, as well as having minimal supervision at meal times. Usually there is an 'eat what's on your plate' rule with a nurse watching you, even if is a less hospital-like environment such as Ellen's facility. This is certainly unconventional, as well as their random trip to the art exhibition, which seemed well-thought-out. Often trips out are for people much later in their treatment and are usually decided by the patient or to fellowship meetings or food outings, rather than a group trip to somewhere unique.
4. Dr Beckham - he may be a little annoying because he does come across quite smug and all-knowing. In fact, I think he puts Ellen at risk later in the film when he allows her to leave without being stopped so she can reach her 'rock bottom'. In real life at this point she would probably have been sectioned. But to give him credit, he does show genuine care. And to say that him and Luke are solely responsible for her readiness for recovery is just ridiculous. Everyone changes at their own rate and what causes Ellen's change in attitude is her rock-bottom experience for which nor Dr Beckham or Luke were actually present. 
5. Depiction of anorexia - yes it is true that Ellen wears eye-liner for most of the film. But I think we need to cut the film makers and costume designers some slack! Having an actress in make up and then reducing that level of makeup to coincide with the character's decline in physical and emotional state is a very common tool employed. At the end of the film due to her reduction in makeup, Ellen's appearance as someone very unwell is believable.

What I didn't like about the film:

• Luke is seen as very good for Ellen, because he is the only one who seems to have any kind of influence over her behaviours. But when Ellen leaves and he says to her that he 'needs' her, alarm bells rang for me. Perhaps this was to elicit emotion from the viewer, but it is a sign of real illness and codependence from him. If he is one of her more rational guides to recovery, despite still being unwell, I don't see why this bit had to be added in. 
• Talk of calories and weight. This seems to be a given for a film about anorexia but I don't think it has to be. I think it could have been made more accessible to all audiences, including those with eating disorders, if that had been skipped. Though then critics would probably have attacked the film saying it is a poor depiction of anorexia!
• The inpatient house is a little unrealistic. Part of a healthy community within inpatient is to actually encourage the 'snitching on' of patients who are acting out. There is no way you'd find a bag of vomit under someone's bed and not at least feel compelled to tell someone. That said, perhaps it's a sign of how unwell Ellen really is at this point.
• I did feel a little like the movie was cut short. But I think audiences have to understand that the film is not about her recovery. It is about a change in mindset which allows her to approach recovery with the commitments she needs for her own health.

In all, a great film if you remember that it's not trying to depict Ellen's entire recovery journey. It pulled me in emotionally and will strike familiarity with anyone who's experienced an eating disorder and its effects on yourself and your friends and family. 

Image from here
If you wish to watch To The Bone, it is available on Netflix.