“To The Bone”   

There is nothing new about the depiction of mental illness through film or television.  “Mental illness” is a part of the human condition.  The history of any person’s individual struggle with mental illness is as varied and complex as our fingerprints.

Anorexia, a subset of eating disorders, is no exception.

The film “To The Bone” featuring Lily Collins and Keanu Reeves, depicts one young woman’s struggle with anorexia and one doctor’s unconventional approach to treatment.

First, let me play amateur film critic: I was disappointed in the lack of depth and artistry.  The content provides any writer or artist a rich palette of emotions, relationships, Self, and healing practices to draw from—but it fell flat for me—surface level. In many ways, the film felt anorexic—starved of deep feeling. I was hungry for more.

Other people’s critique of the film is that it re-enforces dangerous stereotypes of what an anorexic “looks like.” I concur.  There is a popular image of the bony, attractive, and sullen Caucasian female that most people imagine when they think of an “anorexic.” Most clients I have treated, even the ones who are entering into ketosis (when the kidneys begin failing) or brady-chardia (dangerously low heart rate), wouldn’t be recognizable by any of these outward measures. Sometimes, they are the “most attractive” person in the room. This is especially true here in Orange County, CA—where the practices of “eating clean” and exercise are part of the rituals of the new religious paradigm—the Religion of Thinness (Michelle Lelwica). I saw anex-client of mine the other day at a concert—she is stunning and does not appear “bony”—she often models for high fashion photography spreads.  Her struggle in therapy was her fear that if she began to eat what her body wanted, her body would likely change. She was in quite a catch-22 when it came to letting go of her eating disorder.  It’s never about food.

One thing the film gets right: it is very educational.  It demonstrates the basics of eating disorder behaviors—from rituals at the table, eating strange foods, exercise compulsion, and the absolute terror of eating.  Most family members that I have worked with are genuinely confused about what is going on and often overlook behaviors simply because they don’t know what to look for. They are lost.

The doctor’s approach to treatment was beneficial—he did not use the conventional “meal plan” approach. He gave patients total control over their food intake but gave consequences for not reaching weight goals. A critique I have of most eating disorder treatment centers is that they feel very controlling.  Unwittingly, most centers re-create a negative interaction between client and food by “punishing” certain behaviors and rewarding others—specifically at the table.  Most centers are not psycho-dynamically oriented; they do not see that their approach re-enforces the problematic schema in the patient’s mind.  Conversely, I have found that a warm, connected, attachment oriented approach to most ED clients is highly beneficial.  A calm, non-judgmental attitude does wonders for the highly anxious client.  When the treatment provider stops being anxious about the client’s eating disorder, the client can begin to get curious about their behaviors and sometimes symptoms abate spontaneously. The trouble is that this process happens on the clients’ timeline—not the therapists’ or the family’s. I have had many a family member terminate treatment or demand treatment to be different because it’s not “happening fast enough” so therefore, something must be wrong. But as we saw in the film, Ellen only got better when she decided to get better.  This is usually because at the heart of an eating disorder is the assertion that “my body is mine.”

I would have loved to have this theme explored more in the film—it was touched on briefly by Luke, when he asked Ellen if she was ever “touched wrong.” In my experience, even if a client was never sexually abused, most of my female clients have internalized the patriarchal attitude towards the feminine—which is to diminish its existence—to control it—to subdue it—to minimize its wildness—and, her sexuality.  The “mother/whore” complex is thriving. I see it everyday in my practice.

The history of Western civilization for the past two thousand years has been vicious towards the female body because of its association with sex, blood, and childbirth. It is connected to nature and Her ways and cannot be thwarted or controlled.  The female body changes with every week, every month, every year—it has many moods and seasons—and is constantly in flux. The female body has been maligned for its ever-changing ways. The body—both male and female—has been subject to Hellenistic dualism and has suffered the consequences of elevating the “mind” over the body.

Fortunately, thanks to science and an evolving theological landscape, Western thought is moving towards a synchrony of mind and body—those of us that study the body and mind are now saying it is more accurate to say we have a body/mind—because the neural networks that extend throughout the body, transmit messages to the brain. Most of our neurotransmitters are made in the gut—which is why when we are “emotional.” our ability to eat normally is impaired.

There was a scene that brought me to tears. The scene captured the complex and at times uncomfortable aspects of treatment: the scene where Ellen’s mother asks if she would like to be bottle fed. Initially, Ellen bristles—but then softens at her mother’s offering. Her mother cradles her twenty year old daughter like an infant and begins to feed her. And Ellen receives nourishment from her mother.  After this scene, Ellen decides to return to treatment. Although the movie depicted this important psychological move too swiftly for reality, it demonstrated a key principle: which is that we learn how to care for ourselves by the way others care for us.  Ellen decided to begin feeding herself after being fed. It really is that simple.