The Netflix Movie To The Bone – Questions, Answers, and Resources for Therapists and Clients


Amy McManus, LMFT

The Netflix Movie To The Bone – Questions, Answers, and Resources for Therapists and Clients
by Amy McManus, LMFT

Once again, a Netflix release sparks intense discussion about its depiction of a mental health issue. The feature film To The Bone, released July 14, is the story of Ellen, a 20-year-old girl who suffers from an eating disorder (ED), specifically from Anorexia Nervosa.

As with their earlier release, 13 Reasons Why, a series about a fictional teen suicide, there is a fair amount of public outcry. This film, To The Bone, though far from perfect, does a better job of giving an important and positive message to the public. Just about everyone can agree that building awareness about mental health issues is a good thing; glamorizing it is not. So the questions here are:

  1. Does this show build awareness of a mental health issue, namely EDs?
  2. Are eating disorders glamorized and/or depicted in a harmful way?
  3. Does this movie offer hope for recovery from EDs?
  4. What advice and resources can I give my clients who have questions about this movie or eating disorders in general?

1. Does the Film To The Bone Build Awareness of Eating Disorders?

Well, the movie certainly has “sparked a conversation,” as actor Alex Sharp tells Access Hollywood in a joint interview with Lily Collins, the actress playing Ellen.

Only through public awareness can we reduce the shame that surrounds ED’s, and increase the empathy for ED sufferers.

Eating disorders are the third most common chronic illness among adolescent females. But adolescent females are not the only people who suffer from eating disorders – 30 million people of all ages, economic classes, and ethnicities will suffer from an ED in their lifetime. In fact, 1 in 8 women over age 50 engages in disordered eating behaviors. Middle aged women are the fastest-growing segment of the population with ED’s.

In this aspect, the movie To The Bone falls short. It does not depict the diversity of ED sufferers in the population in general. Of the seven patients in the recovery center where Ellen goes, six are white and only one is a woman of color. Only one is a male. All but one of the patients is there for anorexia or bulimia – one woman is there for binge eating without purging. There is no mention of other EDs such as pica or rumination.

Additionally, it is a shame that the movie missed a wonderful opportunity to explain to the public that there is help available to those who might not be able to afford a tony avant-garde treatment center such as the one run by Dr. Beckham in the movie. Insurance companies are required by law to cover treatment for eating disorders, though clients may have to advocate vociferously to get their needs met. Therapists can help with this process, as well as psychiatrists and general practitioners. 

The public needs to be made aware of the resources available for information and help for eating disorders.

The movie falls way short on this count. They do not even list a hotline or any other resources at any point in the movie. There is no mention in the script that these resources exist. This is a glaring omission from the production, and I am surprised that the group Project HEAL that consulted with Netflix was not listed anywhere before or after the film. The cast of the movie did do a public service announcement about EDs, but there was no link to this either. 

2. Are Eating Disorders Glamorized and/or Depicted in a Harmful Way in To The Bone?

This is a matter of some debate. The protagonist in the movie, Ellen, is played by the beautiful doe-eyed Lily Collins. She goes to a lovely treatment center in a custom Craftsman home and is treated by the handsome Keanu Reeves. A cute boy falls in love with her in treatment. None of these is typical in real life. Except that, in real life, the beautiful doe-eyed Lily Collins actually DID have an eating disorder. She has spoken about it in the media, and in her recent book, Unfiltered. Collins speaks about how she suffered from an ED as a teenager, and how she hopes this movie will build awareness of eating disorders. What she does not talk about with Access Hollywood is how incredibly painful it was to have an ED, and what a long, long haul it is to recover. Collins also talks about how she lost a significant amount of weight for the movie, but she claims it was safe because it was supervised by a nutritionist. This situation is extremely irresponsible of the filmmakers, and is expressly not endorsed by Project HEAL, the non-profit organization that Netflix consulted with for this film.

Will all this inspire impressionable young women to imitate her disordered eating behavior? Maybe. There were some poignant moments, but mostly the movie explained the mindset of the ED sufferer more than the actual pain. The mindset of the person with an ED can be difficult to understand for someone with no experience of this personally, and the movie did show some of the typical examples of distorted thinking. This can be tremendously helpful for confused friends and family as they try to understand what is happening with their loved one.

What was noticeably missing from the movie was any meaningful discussion of why Ellen, or any of the other patients, had an ED in the first place. The emphasis was on food and weight, and not on the personal meaning of the disease to any of the individual patients. There was some depiction of Ellen’s dysfunctional family dynamic, but the meaning of this dynamic for Ellen was never developed. Although family therapy is almost always integral to recovery, in this movie, the doctor gave up after just one session. The movie doesn’t show how recovery occurs, but it does offer hope. 

3. Does To The Bone Offer a Message of Hope for Recovery From an Eating Disorder?

Though the movie does not show us how this actually happens, the message is hopeful overall. It does show us the reality that recovery is a complicated process, with both forward and backward movement. It shows us that Ellen did re-connect with her mother and her stepmother, and she did choose to go back to the treatment center, clearly with more of a buy-in than the first time. 

4. What Are Some Resources I Can Offer My Clients?

Hotlines 

For confidential and free support about eating disorders, contact the National Eating Disorder Association Hotline at 800.931.2237. You can also IM with a volunteer at nationaleatingdisorders.org. 

For crisis situations, text “NEDA” to 741741 to be connected with a trained volunteer at Crisis Text Line

General Information 

ANAD – The National Association of Anorexia Nervosa and Associated Disorders

This is an excellent website with information about eating disorders, and also a great place to find all kinds of resources like support groups, therapists, nutritionists, doctors, treatment centers, etc. They also offer online support groups.

Supporting a Loved One

Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T) – An international organization of and for caregivers of eating disorder patients. F.E.A.S.T. serves families by providing information and mutual support, promoting evidence-based treatment, and advocating for research and education to reduce the suffering associated with eating disorders. http://www.feast-ed.org/

Treatment Centers

Eating Disorder Referral and Information Center offers a comprehensive search for eating disorder treatment centers across the country at edreferral.com.

The Alliance for Eating Disorders Awareness has a directory of over 200 treatment centers all over the country. https://www.findedhelp.com/

Body Image 

Body Positive – Focuses on boosting body image at any weight. www.bodypositive.com

Amy McManus, LMFT, specializes in communication between parents and teens. Amy previously worked for four years as a school counselor in various high schools in Los Angeles. She has raised four teenagers of her own, and is married to a high school teacher and administrator. Amy’s weekly blog (http://www.thrivetherapyla.com/blog/) offers parenting tips and other mental health information for parents and teens. You can contact Amy at amymcmanuslmft@gmail.com.