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.

Transformation Cannot Be a Checklist

This post came fairly naturally. After a month of lots of deadlines I wanted to write up a new post. So.. the topic is trauma processing, recovery and checklists. It's becoming quite common to find yourself at a low point, bogged down by past experiences. So how is it best to get going and maintain a good recovery and way of life?

For myself, any change coming up is often accompanied by a mental checklist. I'm going on a trip. I need these things. I'm cooking a meal. I need these things. I'm grieving a loss. I will go through these things and will need these things. I think this is fairly common.

Now imagine you've started a life transformation. You ask around for advice, or go on the internet, and you're told 'it's a process'. Transformation is a process, in that it takes time and there are many stages. It might be tempting to look at it as a list, or look at your issues as a list. For example:

• Sort out sleeping pattern.
• Stop smoking.
• Go to the gym. 
• Eat healthily.
• Talk about my problems.
• Get over x, y and z trauma.
• Be left with a 'clearer' life. 

This is a great way to see where you're at. However, in looking at it as a way to guide your process, there could be some problems:

1. Can feel never ending.
   Having a long list of tasks in front of you can be overwhelming. The truth is, we are growing constantly through our lives, making mistakes and trying to make the right decisions. Sometimes that means making the wrong ones.
   
   This means that even if you make a list and get through it, more can always be added. That feeling of completion you are striving for will never be reached.
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2. Lack of recognition for other achievements.
   Like a dog chasing a bone on a stick, you will miss the little achievements you're making if you're constantly looking forward for the next one. Transformation requires recognising all the steps you're making, even the tiny ones.
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3. Makes it about control.
   Releasing past experiences and traumas and their effects on your daily life is about letting go of control. It's about accepting all the emotions that come with kindness and toleration. Sometimes a list can create impatience, and if your recovery goes 'off track' it can leave you feeling very lost.
   
   As humans we crave for the world and our experiences to make sense. In recovery you will come across lots of unexpected bumps and hurdles - unexpected emotions or experiences. Having a mental (or physical) list often does not allow for these, which is what's needed.

That is not to say that lists can't be helpful. They are great starting points, and good for showing you where you're at. This is why workbooks, such as CBT books, often use tables where you write your current thoughts down, and where you want to get to. 

However, the general message is that letting go of your list as needed is very important. Notice when you're feeling like you're 'off track' from your list, and be accepting of that. Because true transformation is about accepting yourself unconditionally, whether you're on track or not.

Image from here

Surviving Freshers If You're Not There

I have taken a little blogging break to focus a bit more on myself and my own personal growth, but here is my first blog back - based on freshers.

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As someone who has 'fallen behind' in the educational system a couple of times, I wanted to give some advice on surviving (and thriving) at what can be a difficult time of year!

Does the following list sound familiar? 

1) Comparing 

When friends start posting pictures of themselves having fun at freshers in their new halls with new friends, do you find yourself comparing? When I left uni I could barely look at my Facebook news feed without feeling sadness and inadequacy. 

I even felt guilty for feeling so sad about my friends having fun. It was a dark time full of comparisons. What I was doing seemed so inferior to the fun and life usefulness of uni. 

2) 'What ifs'

'What if I'd just not taken a gap year?', 'what if I'd worked harder?' and 'what if I'd made the best friends ever if I'd just gone this year?' might all be questions circling in your head. Everyone's reasons for going to uni or not are different and personal, but it can be particularly hard if it wasn't exactly your choice. 

If you haven't gone because your grades weren't enough, or if you need to redo year 13, or if you have been advised by medical professionals to leave it a year, your head might be filled with these 'what if?' questions. 

3) Placing judgements on yourself 

Judgements on yourself are all-too-common in situations where you feel left behind. Thoughts we have about ourselves can be really automatic and unnoticed - thoughts like 'I'm such an idiot' can be so self conscious that we barely notice them, but they're still there. 

4) Loneliness/isolation

As a result of a large amount of our friends departing for uni, we can find our support network is quite depleted, or sometimes non-existent aside from our families. This can be a really lonely time. 

You might've noticed a common theme among the previous list. Your friends going to uni and being at freshers has become a reflection on you and your abilities. This isn't good for self-esteem, which luckily can be built up in quite a few ways by some simple changes:

1) Less social media

It's tempting to look, but it might be a good idea to take some time away from social media. Maybe just focus on your own posts. Leave those lists of recent updates on Snapchat untouched. If you feel you need to be on it, think about things you could post rather than looking at other peoples' posts.

2) Support network

If a lot of your friends have left, focus on making new friends. Part of having a support network is having people you can see face to face and speak to - do not try to convince yourself that having friends miles away who you only see at Christmas, Easter and Summer is enough. 

Having a support network is not just about friends. It can include seeing your GP for physical or mental health problems, having a therapist if you feel you need one, or if you are redoing a year at school it could include a teacher or tutor. 

In terms of making and maintaining friendships, this website has some good advice. Maintaining friendships is as important as making them - so make time for this in your life.

3) Recognise the benefits of working through this.

It's important to not forget that this 'left behind' feeling can happen to all of us, all through life. It is not unique to when your friends are at freshers. This can be a depressing thought, but also quite empowering. If you can get through this in a healthy way, then when your friends are getting married, having kids etc, if you feel left behind you will know how to cope healthily. 

4) Enjoy yourself!

Spend time enjoying yourself, whether this means getting active, shopping or relaxing in bed, dedicate time to yourself (and lots of it). Remind yourself of why you chose not to go to uni this year, or the benefits of not being at uni. Building yourself up and your self esteem will help you to heal and spend time in a healthy way.

Image 1 from here

Image 2 from here