Telling the story of Ellen, a teenager in treatment for anorexia, “To the Bone” is Netflix’s latest controversial creation. But is the film’s depiction of eating disorder therapy on target, or does it miss the mark entirely? The Recovery Village sat down with an eating disorder professional to talk treatment misconceptions, recovery realities and what more people need to know about eating disorders.
Whether you are watching “To the Bone” out of curiosity, have battled an eating disorder in the past or know someone currently struggling with one, it’s important to take the film with a grain of salt. While this movie opens up the conversation on eating disorders, it doesn’t tell the whole story. Here are some of the top concerns and discrepancies within the movie from the viewpoint of Christina Purkiss, program director at Blue Horizon Eating Disorder Services.
1. Eating disorder treatment facilities aren’t houses where everyone just hangs out.
“The movie was on the right track with portraying the depth of mental anguish caused by eating disorders, but treatment is where they took too many liberties,” says Purkiss. In the film, patients are given the freedom to act out on behaviors. “Real treatment is much more organized, and most programs have a very structured day.” Unlike in the movie, eating disorder patients don’t roam freely, living off their own schedules. “At Blue Horizon, all of our patients are together, but they all have different education and therapy sessions. For example, binging individuals received separate nutrition guidance during the day geared toward their specific illnesses,” Purkiss explains.
2. Family therapy doesn’t end after one difficult session.
“In the movie, the therapist’s response to a single family therapy session was, ‘Well, that was terrible, we’re never doing that again,’ but dysfunction is to be expected, not dismissed,” says Purkiss. Given that a large number of eating disorder patients are adolescents, family therapy is an essential part of healing; the way the film portrayed it was a huge oversight in the eyes of Blue Horizon’s program director. “The main point of treatment is to help resolve the issues and help the family move through it; it’s never to say ‘your family is a lost cause,’” she affirms.
3. A “tough love” counseling style usually isn’t realistic or effective in eating disorder therapy.
Keanu Reeves appears to be one of the most humble, compassionate souls in Hollywood. So when his fans watched “To the Bone,” many weren’t enthralled with his portrayal of a hardened therapist with some bitter advice. Ironically, individual counseling for eating disorders doesn’t typically take a cynical approach, either. “Often, patients come to treatment feeling very ambivalent toward change. Because eating disorder behaviors serve a purpose, and usually act as a maladaptive coping skill, it can feel scary and overwhelming to think about letting go of the behaviors,” Purkiss says. “Instead of taking a ‘tough love’ approach, I believe it is more beneficial to validate the fears and concerns a patient has about changing,” Purkiss affirmed.
4. Young white girls aren’t the only people who struggle with eating disorders.
When people envision someone who struggles with anorexia or bulimia, they often think of a white, teenage girl. Unfortunately, the film reinforced this stereotype with the main character, Ellen. The directors did, however, make some efforts toward diversity. “I like that they had a male in the treatment center. That’s a very underrepresented population,” says Purkiss. “It was great that they also included an African-American patient, and a pregnant woman … the illness doesn’t magically disappear when you get pregnant,” Purkiss added. “Eating disorders can affect anyone at any age, too. At Blue Horizon, we’ve had some patients who left in their 70s,” says Purkiss.
5. In eating disorder treatment, mealtimes aren’t a free-for-all.
This was arguably the biggest oversight in “To the Bone,” and it left many viewers confused and eating disorder professionals frustrated. The patients in the film were given no structure around meals, which is unrealistic in most facilities. “The setting they showed isn’t just far from the truth, it would have been incredibly triggering for people at the table,” Purkiss explains. “In most cases, patients do eat together, but are served appropriate meals that fit their individual meal plans, whether or not they eat it,” Purkiss adds. “A jar of peanut butter is incredibly unreasonable,” she says.
6. There’s no perfect way for a movie to portray anyone and everyone who struggles with an eating disorder.
“To the Bone” was a step in the right direction, the film toes the line in some aspects, and struggles to portray the truth. “I am happy that there have been more efforts to shed light on eating disorders, as it can help increase knowledge and awareness of this illness,” Purkiss says. “I think the film attempts to display the mental struggles of living with an eating disorder, as well as the symptoms that may come along with that (i.e. restriction, chewing and spitting, laxative abuse) which some people may view as glamorizing,” she says. “Filmmakers need to be cautious of displaying symptoms in a realistic way without glamorizing the illness, or giving viewers new ideas — it’s a fine line between the two,” Purkiss explains.
If you’ve struggled with one of these disorders in the past and are planning to watch “To the Bone,” or any other potentially triggering production, be prepared. “At the end of the day, with anything that focuses on mental illness, you have to be a smart viewer,” Purkiss explains. “If you’re in a bad place with the illness, it’s probably not a good idea to watch it, or if you plan on it, be prepared to process your reaction with a therapist or someone on your treatment team.”
Although “To the Bone” may have been made with a Hollywood approach, it’s important to keep the conversation open about the realities of anorexia, bulimia and other disorders. “My hope is that people who watch this, even with no eating disorder, understand the severity of the illness. People assume that these disorders are a choice, or it’s a phase to grow out of or a vain attempt to look better,” Purkiss says. Eating disorders are a serious mental illness and deserve to be treated as such. And at Blue Horizon, Christina Purkiss’ team makes sure each individual receives compassionate, comprehensive care. If you or a loved one is considering treatment for an eating disorder, Blue Horizon is here to help.
Meet Christina Purkiss, Program Director for Blue Horizon
Christina Purkiss, MA, LMHC, has worked with individuals with eating disorders, as well as other various clinical disorders including substance abuse, depression, and anxiety. A licensed mental health counselor, Christina provides individual therapy, family sessions, group therapy, and education groups to patients. Her therapeutic approach involves implementing different types of therapies into treatment plans, like dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT). Christina strives to develop a therapeutic relationship consisting of trust, respect and collaboration in an effort to create a safe environment for recovery.
If you are struggling with an eating disorder, know that someone is always there to help. You can contact The National Eating Disorders Association (NEDA) hotline, live chat or text line anytime to get the help you need.