June 2017 marked my entrance into an annual winter cocoon. Sitting at my desk, I was wrapped in a well-loved, faded pink blanket, wearing Grinch print pyjamas and clutching a pug mug. With four months left to write my thesis, I was buried under scattered, highlighted articles, racoon eyes forming. In desperate need of a break one night, I retreated to YouTube in the hope of numbing my brain with cat videos. But no cerebral anaesthesia lay in store for me that night.
First in my trending videos was a trailer for the highly anticipated Netflix film, To the Bone. For those who didn’t jump on the bandwagon last year, To the Bone is a 90-minute drama focused on the experience of 20-year-old Ellen, a young woman, played by Lily Collins, living with and attempting to recover from anorexia nervosa. The audience catches a glimpse of Ellen’s life as she enters residential treatment, struggling to come to terms with her illness in the face of family upheaval, tragedy, guilt and relationships. As I watched the preview, I shook my head with increasing ferocity, my internal monologue crying, “No, no, no, no.” My eyes immediately pounced onto close-ups of a starved, pale Collins as shots revealed her running up stairs, sculling water and picking at her nails over dinner plates. “I know you want it, so come and get it,” the background song repeated.
Sharp, acid-tongued dialogue coursed through my headphones.
“Two-eighty for the pork, 350 for the buttered noodles, 150 for the roll and 75 for butter.”
“It’s like you have calorie Asperger’s…”
“I’m not going to treat you if you aren’t interested in living.”
I quickly realised there’d be no relief from my thesis that night. My work actually consisted of researching a phenomenon I first encountered during my own treatment for anorexia nervosa ten years ago. I vividly remember the copies of eating disorder memoirs that sat on patients’ bedside tables, thoroughly dog-eared and underlined, with passages often committed to memory. Yet, many sufferers did not view these harrowing accounts as recovery inspiration. Instead, they were used as manuals of disordered “tips and tricks”. Since recovering, I set out to investigate how and why this process of maladaptive interpretation develops, its place in the psychopathology of anorexia nervosa and how writers can minimise the risk of their accounts of illness being harmfully interpreted.
How to safely represent eating disorders is the debate migraines are made of. When the trailer for To the Bone was released, The Butterfly Foundation for Eating Disorders responded with a trigger warning statement in the first twenty-four hours. Similarly, youth mental health organisation Headspace expressed concern that the “portrayal of behaviours associated with an eating disorder … may be providing a how-to guide for adolescents who may be at risk”. However, some critics argue that the inclusion of trigger warnings based solely on the revelation of emaciated bodies may themselves be harmful, suggesting eating disorders to be purely image-centric, cultural phenomena, as opposed to life-threatening illnesses.
Critic Hadley Freeman claimed the film “reduces anorexia to an aesthetic expression”, leaning on “wearily outdated tropes” while stereotyped characters are “ticked off with the regularity of hospital mealtimes”. Indeed, the protagonist of Ellen strictly aligns with the tried and true stereotype of a white, young, upper-middle-class female living with restrictive anorexia. Fellow patients do add a smidge of diversity to the film: there’s a male with anorexia, people living with bulimia, lesbians suffering from eating disorders and even an African American woman with binge-eating disorder. Intersectionality for the win, right? Well, not exactly. To describe these characters as “supporting” would be a stretch. Rather, they exist strictly on the periphery of Ellen’s spotlight.
In turn, the film perpetuates the damaging notion that eating disorders only develop in one form, and affect only one type of person. It neglects the opportunity to raise awareness of a diverse range of eating disorders that affect an even more diverse range of people—especially considering that 97 per cent of eating-disorder sufferers do not meet diagnostic criteria for anorexia specifically. This focus reflects the inaccurate cultural attribution of thinness with eating disorders—the idea you’re meant to “look” unwell in order to be so. What about the exploration of eating disorders we can’t obviously see? Ultimately, To the Bone invalidates any eating-disorder experience dissimilar to Ellen’s—if it doesn’t fit into a specific mould of her eating disorder, it’s deemed unworthy of screen time and broader social concern.
Furthermore, the film offers insight only into the treatment options for the privileged. It is not uncommon for treatment costs to exceed US$40,000 per month—none of which is covered by major insurance companies. Where is the exposure to eating-disorder treatment for those without financial access to the best? Is there any way to recover if you can’t afford residency at these facilities? Such narrow representation only perpetuates the misconception that eating disorders are diseases of privilege, a glamorous illness to be healed by glamorous means.
The film also fails to explore the connection between Ellen’s circumstances and her drive to starve herself. Rather than navigating the question of the why behind self-destruction, the film merely touches on surface symptoms. Therapy sessions make a minimal appearance (with the exception of a chaotic family-group session and a manufactured scene of uplift towards the end). To focus on only surface symptoms and fluffy treatment without any exploration of causation trivialises the psychiatric illness with the highest mortality rate of all mental disorders. When such representations are continually provided to the public, it’s no surprise that decades-old misconceptions about these illnesses prevail.
Louis Theroux’s documentary Talking to Anorexia also premiered in late 2017—sans trigger warnings and media mania. Theroux circulated among two public inpatient and one outpatient eating disorder services in central London, acquainting himself with several clients in treatment. Theroux’s documentary similarly focused on restrictive anorexia, but it focused on the lesser-discussed and horrifically painful realities of living with the disease. The documentary featured many of the daily struggles I myself experienced during treatment: staff supervision of meals and bathroom breaks, strict meal plans, blind weigh-ins. Yet, what Talking to Anorexia explored that To the Bone neglected was the severe self-hatred, loss of life, joy and opportunity that imprisons sufferers of eating disorders.
One sufferer, twenty-seven-year-old Jessica, had been living with anorexia for nine years. The trendy eyeliner, oversized sunglasses and acid-tongue of To the Bone’s Ellen were replaced by exhaustion, fragility, fear and shame. Cowering in her seat and avoiding eye contact, she confessed, “I do 2,000 star jumps a day. I feel really ashamed. It’s quite hard to admit to it. It feels like a shameful secret that I have to hide.” Although a fully qualified teacher, she had never held a full-time job due to her illness and cyclic periods of hospitalisation. Jess confesses, “It’s a self-punishment thing. I don’t deserve to eat. I don’t deserve nice things. I don’t deserve to enjoy myself. I restrict food and exercise as a punishment to myself.” A chill ran through me as I thought of my own adolescence, riddled with a deep, sincere wish for death, just to be free of my own self-loathing. Looking at Jess, I saw not only a reflection of the hopelessness I once lived with constantly, but the path my life may have taken if recovery never occurred
The research I did for my thesis stressed the importance of a writer’s self-awareness of their recovery stage, distance from illness and choice of material when recounting their experience. It begged a return to fundamental questions of what are we creating, how are we creating it, whom are we creating it for and why. When To the Bone and Talking to Anorexia were released last year, I was reminded of this topic’s natural extension into all forms of creative creation and a likewise need for personal awareness in conjunction with honest and helpful portrayals.
Responding to claims that To the Bone glamorised eating disorders, Lily Collins said, “We would never set out to glamorise or encourage a disorder I and Marti [the director] went through, that was so negative. So, coming from that place, we hope to start a conversation.” Yet, it may be misguided to assume positive intentions, coupled with lived experience, is sufficient to produce work for a mainstream audience, including an at-risk population. It would be nai¨ve to assume any writer or filmmaker has the capacity to ensure and extract a specific response from their audience. As Hadley Freeman wrote, attempting to eradicate all potentially triggering material is to engage in “an impossible game of whack-a-mole”. Yet, taking the risk of maladaptive interpretation into consideration when producing text or film centred on eating disorders is an issue requiring continual exploration. Less focus on sassy dialogue, mascara and biker boots and more on the psychological roots and suffering of eating disorders may make for more painful viewing, but it may also provide a glimpse into the reality of a life-threatening illness with a desperate need to be taken seriously.