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To The Bone: A Glimpse into Struggles and (Mis)conceptions of Eating Disorders

Navya Kapoor

Recently, eating disorders have come into the limelight through movies like To The Bone, written and directed by Marti Noxon. The movie revolves around 20-year old Ellen, who suffers from anorexia nervosa. She journeys through different institutions, all of which fail to help her. The movie crystallizes in the fourth—and final—institution operated by Dr. Beckham, rumored to have a “new and different approach”. The movie presents the struggles faced by the patients in their battle with anorexia and the accompanied social stigma and misconceptions.
In presenting the purging and restricting categories of anorexia nervosa and bulimia nervosa, the core characteristics of the disorders have been demonstrated well—extreme diets and starvation, distorted perception of one’s body image, and a heightened concern with weight. Patients’ distorted perception of their body images can be seen in their attempts to lose weight despite being underweight and extremely skinny. Ellen’s desire to reduce her arm to the size of her thumb and index finger enclosed together stems from her distorted perception. Patients confess their craving for foods like chocolates, cakes, etc. indicating that they restrain consumption of high-calorie foods not because they don't like it but to inhibit weight-gain. Further, the comment by a patient that “I am two years of hungry” (Miller, Curtis, Lynn, & Noxon, 2017) implies that they have been starving themselves for two years. The movie meticulously presents behavioral manifestations of some of the symptoms such as incessant calorie counting, purging, use of diet pills or laxatives, tasting the food only to spit it out (to avoid calorie intake), compulsive exercising and the like.
However, the movie has a major fallacy in the way it represents some aspects of the disorder. It fails to translate the symptoms as part of a larger struggle, instead representing them as a choice; anorexic and bulimic behaviors of the patients have been portrayed to be under their control. While the will to get better and compliance to the doctor’s recommendations positively influence the recovery process, they are not equivalent to having complete control over one’s disorder or the resulting behavior; the patients feel compelled to starve, diet, purge, binge eat or engage in the like (Butcher, Mineka, & Hooley, 2017). There are several instances of this incorrect depiction—during family group session, Ellen’s step-sister expresses her anger at Ellen and comments, “I just don’t get it. You know, just eat” and the therapist does not correct her misconception. The ‘Eat up Ellen’ cake, her mother’s remark, “I accept it now. If death is what you want”, and statements like “why can’t you just eat?”, “okay so eat”, “can you please just try this time?” are a few more examples of the portrayal of this misconception. 
This has major consequences since even contemporary research that confirms the biological markers of mental disorders is not enough to dispel these misconceptions (“Eating Disorders Program”, n.d.). Popular movies like this one reinforce the status of mental disorders in the public imagination. This misrepresentation has serious implications because it underpins the misconception, which leads to blaming the patient, who is at no fault. This further worsens the patient’s suffering.
Further, there are traces of multifactorial approach to the disorder, i.e., the diathesis-stress model. Ellen is shown to have a family history of mental disorders: her biological mother has bipolar disorder. Along with exhibiting Ellen’s dysfunctional interpersonal relationships as socio-environmental stressors, the movie successfully highlights one of the primary socio-environmental causes of eating disorders—glamorization of ‘size zero’ and idealization of the concept of being ‘perfect’. The opening scene shows a teenage girl with anorexia talking about the ubiquity of pictures of “sad fat” girls in magazines or TV which are accompanied by their post-diet skinny pictures that are exclusively loved by people. Further, emphasis is given to reading the poem “Courage” by Anne Sexton that talks about the way people from childhood are exposed to notions of ‘fat’ and ‘thin’. Negative and positive connotations are respectively attached to them, and children “dr[i]nk the acid [of being called fat] and conceal it”. Ellen’s step-mom’s remark, “not too good, not perfect” and Ellen’s comment, “if I wanna be thin, don’t they say that that’s better?” highlight the social appraisal of ‘thin’ as ‘perfect’. The movie does not explicitly deal with these day-to-day social constructs; however, it still does a good job of subtly conveying their role in negatively influencing peoples’ notions of body image.
Some scenes in the movie not only exhibit the physical manifestations of the disorder, but successfully elicit their graveness. Visuals like pale complexion, sunken cheeks, exposed ribs, bruises on the spine due to excessive crunches, and excessive body hair also termed ‘lanugo’ (where the body grows more hair to produce warmth) leave a lasting impression on the viewer’s mind. Megan’s miscarriage due to purging and statements that inform that the body burns muscle and organ tissue after there is no fat left further elicit the serious repercussions of the disorder—a fatigued body, emaciation, medical problems like rupturing of esophagus, multi-organ failure, infertility, and even death.
By virtue of having a large-scale audience, the movie sets into motion a discourse around eating disorders. This has practical implications—it creates awareness and conveys the urgent need to change the social practices that operate as socio-environment causes. Further, this way, parents can recognize and keep a check on their child’s symptoms, since teenagers are the most vulnerable to developing the disorder (“Eating Disorders”, 2018). However, this also necessitates accurate portrayal to not only prevent further propagation of misconceptions but also to facilitate their rectification.

References
Butcher, J. N., Mineka, S., & Hooley, J. M. (2017). Eating Disorders and Obesity. In Abnormal psychology (pp. 299-335). Pearson Education India.
Eating Disorders. (2018). NHS UK. Retrieved from https://www.nhs.uk/conditions/eating-disorders/#.
Eating Disorders Program. (n.d.). John Hopkins Medicine: Psychiatry and Behavioral Sciences. Retrieved from https://www.hopkinsmedicine.org/psychiatry/specialty_areas/eating_disorders/faq.html.
Miller, K., Curtis, B., Lynn, J. (Producers), & Noxon, M. (Director). (2017). To The Bone [Motion picture]. United States: Netflix. 

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