TW: Eating Disorders, Anorexia Nervosa, Bulimia, Purging, and Calorie Counting
Lily Collins and Alex Sharp in To the Bone. Photograph: Gilles Mingasson via Netflix
TW: Eating Disorders, Anorexia Nervosa, Bulimia, Purging, and Calorie Counting
“Your courage was a small coal that you kept swallowing'' is an excerpt from Anne Sexton’s poem “Courage”, the same one that director Marti Noxon wanted 20-year-old Ellen (Lilly Collins), an anorexic girl receiving ongoing treatment to relate to. The dramedy (refers to media that combines elements of both drama and comedy) To The Bone portrays crucial aspects of eating disorders and depicts a reality that many suffer through each day. As the story unfolds with unconventional support systems, recognizable symptoms and budding relationships, we are taken along Ellen’s journey, and learn how she “has all of it under control”.
Unconventional Ways
The opening scene begins with Ellen attending a support group. This not being her first time receiving treatment for Anorexia Nervosa (AN), these sessions seem to be a regular routine for her. After a dismissive comment about another patient’s feelings, saying, “There’s no point in blaming everyone. Live with it” she holds up a poster, with the words “Suck My Skinny Balls” made with newspaper clippings, and then proceeds to storm out. Her crude personality and decreasing weight regardless of how much therapy she has gone through is something that worries her otherwise passive-aggressive stepmother, Carol. When weighing Ellen, her mother says to her, “do you think that’s beautiful?” and that feeds into society's perception of people with eating disorders, and how they think a person dealing with an ED can just “pull themselves together”. The stigma of “why can’t you just eat” creates toxic environments for people suffering from AN, and although this is often expressed as a concern, we can see in the film how it negatively affects Ellen, as during group therapy with her three mothers and sister she says “I’m sorry...that I am not a person anymore. I’m a problem”
Unconventional Dr. Beckam, who was just gaining notoriety for his methods, met with Ellen and after observing her physical and mental health, he says, “the way that you’re going, one day, you won’t wake up. And I’m not going to treat you if you aren’t interested in living.” The audience members at this point, recognize that Ellen understands the consequences of not receiving help and continuing on this path. She feels the emotional trauma that her ED is causing herself and her family members, and it is not to say that the words of one doctor suddenly aid her, but at the same time, she knows that this is the most appropriate step to take in her position. It is important to understand the struggle it takes individuals who are suffering, to continue to seek ongoing help. Relapse rates for anorexia nervosa and bulimia are about 36% and research shows that the highest risk for relapse for AN is in the first 18 months after treatment. (Berends et. al, 2016). At the age of 20, Ellen has had her fair share of experience in treatment centers, and doctors visit because of relapsing so often. That is why Ellen accepting that she needs a different approach towards the rehabilitation of her physical and mental well-being is a large milestone in her journey towards recovery.
Is it Accurately Depicted?
Symptoms of eating disorders are mentioned throughout various parts of the film, and how each patient, including Ellen, experiences it. A common symptom that is accurately shown is self-induced vomiting, also known as “purging”. This is done in hopes that the nutrition ingested will not be counted as a daily caloric need, however, this can lead to many mental health illnesses and physical side effects over time. The acid from vomit can irritate the esophagus, cause tooth decay and destroy teeth enamel, as well as contribute towards high levels of depression and anxiety. Meghan, a patient at the group home, suffers from a miscarriage after long-term self-induced vomiting habits, and other physical aspects that impact her health. A friend, who was just recently “tubed” expresses her sympathy towards her mental health by saying “Megan’s been gaining, she’s flipping out. But, I mean, she wants to, I think for her baby.” This shows that her peers know Meghan is trying to eat for her child, but unfortunately, her eating disorder ends up taking over, and they understand why Meghan decides not to come back. For many patients at the group home, the fear of gaining weight is what restricts them from eating, and because of this we learn about the symptom “chewing and spitting”. Ellen, when having dinner with Lucas after he repeatedly insists on ordering her food, chews the food but proceeds to spit it out in a tissue she keeps handy. This film subtlety depicts different behaviors that those dealing with ED’s may be able to recognize.
Whether it is chewing and eating, calorie counting, excessive arm hair growth, loss of menstruation, or body checking, the movie seems to accurately represent symptoms seen in ED’s, but for who? “Eating disorders come in all shapes and sizes. However, the movie uses a very thin, malnourished, white female to portray someone with an eating disorder.”(2017) Despite the film’s attempt to show diversity within its characters, and content, it all just comes down to the stereotypes society keeps of those dealing with eating disorders. It encourages viewers to think that only those with physical characteristics and symptoms are dealing with Anorexia Nervosa or Bulimia and that it is unlikely for someone who does not fit the description to be dealing with the same. Eating disorders can affect any ethnicity, race, size, and gender, and although this film includes one male and one Black patient, it does not mean that ED’s are restricted to “thin, malnourished, White girls”.
Controversial Responses
Controversial responses to the film’s plot did not stop director Marti Noxon and actress Lilly Collins from continuing on with a film like this one. Various sources have said that the film glamorizes and romanticizes Anorexia Nervosa and that it can be seen when Ellen is calorie counting (naming the number of calories in her food) or following through with her ticks. As pointed out by blog writer Emily Glassey and her piece on “Why Films on Anorexia Will Never Get it Right” she mentioned that towards the end of the film when Ellen is playing out her near-death experience in her dream, it is Luke, one of the residents at the group home and the awkward love interest that encourages her to “eat the coal that is courage” instead of her mom, sister, and stepmother that have encouraged her to do the same for a longer period of time. People dealing with mental health illnesses cannot suddenly be aided or “fixed” by others. That is why despite several doctors and treatments, her eating disorder has stayed with her for half a decade. Why does a boy she’s known for six weeks suddenly put on her the path towards healing? Looking past the influences in Ellen’s life, it is also pointed out that this film can be triggering for some and that viewer discretion is advised. An article posted by the Huffington Post states “if you are suffering from an eating disorder and you see graphic representations of what somebody is doing or has done there is a very real risk of copycat behaviour. It's not a logical choice somebody makes, they're driven to it." Author Mat Whitehead most likely pointed this out because of the consequential actions depicted on screen, and how trigger warnings are important when viewers may mimic or be greatly affected by the content shown. Focusing on the goal the creators of this film wanted, Noxon explains that Ellen is an autobiographical depiction of her teenage self. Her obsession with measuring the width of her arms, is a tick seen in Ellen, where we see her measuring her arm by wrapping her hand around it and making sure her fingers touch, and as one character pointed out “Making sure your arm doesn’t get bigger than, what, a silver dollar?” is something Ellen rolled her eyes at, but ultimately agrees with. Lilly, who in past interviews has stated that she dealt with an eating disorder at the age of 16 by not eating, consuming diet pills, and purging is often asked how she was able to act in this role as Ellen, and if it was dangerous for her. She states, "For me, it was a sign from the world saying, this is probably something that is actually bigger than you. There’s a larger thing in play here and both are going to be able to better inform one another,” (2017, Malenbaum) Noxen and her have both dealt with eating disorders in the past, and their message seems to be “there is no one certain way to heal from anorexia, and no one right way to tell stories about it either.” (2017, Willmore)
The Last Half Hour
The last half hour of the film is a quick progression in Ellen’s life, and it starts with Dr.Beckham providing advice that she refuses to acknowledge, thus leading to her situation escalating. In a therapy session with Dr.Beckham, after Ellen explains to him “I know I’m messed up, but you’re supposed to teach me how not to be'' he replies with “you know how. Stop waiting for life to be easy. Stop hoping for somebody to save you. You don’t need another person lying to you. Face some hard facts and you can have an incredible life.” As Ellen puts it, he basically advises her to -as one would say, “grow a pair”. After storming out of the group home, leaving her friends and possible love-interest subplot that this film tried to carry, she ends up in Arizona where her mother and her partner lives, and experiences an “out of body experience”, something that director and screenplay writer Marti Noxon had herself. In an interview she had with USA Today she explains that, "I was hovering over my bed and I saw myself. And I could see that I needed help. It was the only time that I had compassion for that body. I was like, 'Somebody has to help her.' I was on the brink. I had had palpitations that day. I was very ill and the next thing I knew I was on a tunnel, heading toward a light, and I had this kind of awareness that it wasn’t my time. I chose to come back." (2017, Mallenbaum) This was depicted at the end when Ellen is looking down at her own lifeless naked body, and sitting with Lucas above where she looks healthier and is possibly a better version of herself.
The film ends with Ellen swallowing a piece of coal, in reference to the poem “Courage” by Anne Sexton, and when she is awoken she is seen rushing back to the in-patient group home, meeting once again with Dr.Beckham and her roommates seeking help and rehabilitation. It is always important to remember that taking the necessary steps towards treatment is difficult for those dealing with mental health illnesses and that just because Ellen is seen going back to receive help, does not mean she is “fixed”. She is continuing on with her journey towards a higher quality of life.
During the month of May, countries worldwide recognize this time as Mental Health Awareness month, in hopes that individuals who are dealing with mental health illnesses can receive the help they deserve. “1 in 5 people live with a mental illness in a given year, but 5 in 5 people deserve mental health supports'' (MHAnational, 2021) The Bottle Project encourages that if you or a loved is suffering from mental health illnesses such as an Eating Disorder, then please reach out to us or any of the resources listed down below. They can be accessible by text message, phone, or email when applicable.
To start treatment, please call 416-907-9013 or visit https://www.eatwellhealthcentre.ca/eating-disorder-treatment-ontario/?gclid=CjwKCAjwhMmEBhBwEiwAXwFoEYlPaxsgwWYWKJX-IMmCVhbcIQ5H9KbkqlptzrO1Pw4DhB0bjE0JLhoCTX4QAvD_BwE
The National Eating Disorder Information Centre (NEDIC) provided information and resources to support those affected by eating disorders. Visit their website:
For more information and help with Mental Health, visit CAMH
Works Cited
To the Bone. (n.d.). Retrieved from https://www.imdb.com/title/tt5541240/mediaviewer/rm3499840512/
Mallenbaum, C. (2017, July 15). 'To the Bone': The real-life story behind the emotional bottle-feeding scene. Retrieved from https://www.usatoday.com/story/life/entertainthis/2017/07/15/th/466855001/
Willmore, A. (2017, July 14). "To The Bone" Shows There's No Right Way To Portray An Eating Disorder. Retrieved from https://www.buzzfeednews.com/article/alisonwillmore/got-it-under-control
Yandoli, K. L. (2019, December 20). The Reason Why Anne Sexton's "Courage" Poem Is Featured In "To The Bone". Retrieved from https://www.buzzfeednews.com/article/krystieyandoli/your-courage-was-a-small-coat-that-you-kept-swallowing
(n.d.). Retrieved from https://www.nationwidechildrens.org/family-resources-education/700childrens/2017/08/to-the-bone-and-eating-disorder-treatment-did-netflix-get-it-right#:~:text=This is known as “body,in all shapes and sizes