I’ve struggled to start writing this post about To The Bone because the task seemed too big.
How can I put into words how strange it is to even see a movie entirely about an eating disorder; how frustrating it was to watch and yet how grateful I am that more mental health conditions are getting recognition; and how removed I feel from my own eating disorder, yet how easily I can dig up those old emotions? It’s just a lot. I know I won’t do the best job or a remotely complete job, but talking about eating disorders is hugely important to me so I’m just going to give it a try.
For those of you that are newer around here, I’ll explain. I started this blog seven years ago, soon after my recovery from Anorexia Nervosa. I was learning how to navigate healthy living again and I admittedly did a pretty terrible job at it for a while. Much of that was documented here. I was exercising too much and still being way too strict with my eating. I was at a “healthy” BMI, but I wasn’t getting my period. Finally I had to get up the courage to ditch all the rules, gain whatever weight my body wanted to, and start to eat and live intuitively. And damn it’s amazing on the other side.
But for about three years, from age 17-20, I was really sick. My experience with Anorexia was pretty different than what is shown in To The Bone. (Though that’s not to say that the movie’s description is wrong. Every patient’s experience is unique.) First of all, I very gratefully never had to be hospitalized. I likely should have been at certain points, but it never happened and I was able to get better through outpatient care. Alternatively, the movie shows a twenty-year-old girl that has been through multiple inpatient stays and is finally convinced to try out another doctor’s unique approach to treatment. The movie makes no mention of how difficult it is to get insurance to pay for treatment . So many patients can’t get the treatment they need because they can’t afford it. So many insurance companies kick patients out of the treatment before they are truly ready. It’s an unfortunate mess.
A few things the movie does well include showing multiple different types of people with eating disorders – ages, genders, race – as well as showing that nothing is ever skinny enough because it’s not about the weight. The movie exposes some of the behaviors commonly used by patients with eating disorders, such as obsessive calorie counting, purging, exercising in secret, pushing food around on the plate, laxatives, etc. By the way – I definitely nodded my head at the “calorie Asberger’s” comment. It’s totally not cool to make jokes about any Autism Spectrum Disorder, but a pretty spot-on analogy of how well many people with Anorexia Nervosa learn the calories in everything.
And while the movie displayed some of the struggles that occur with Anorexia Nervosa, it’s almost impossible to fully show the constant mental anguish. I told a friend of mine that a great movie about Anorexia would just be a feed of the thought process throughout the day – getting dressed, dealing with meal times, hanging out with friends, holidays with family, the stares from strangers, the well-meaning but terrible comments from friends. Food is a necessary part of our lives, and one that is used to celebrate and socialize, and so for people with Anorexia Nervosa that big part of life is incredibly stressful. There is anxiety, fear, strategizing, lying. It is consuming and exhausting and isolating. It ruins friendships and relationships, some of which are never recoverable. I still am frustrated by the friendships I damaged years ago.
What the movie didn’t talk about is how its almost impossible to decide to recover until you’re eating more. The brain doesn’t work properly when it is chronically underfed. One of the hardest parts about treating Anorexia Nervosa (and many psychiatric diseases) is that patients in the depths of the disease don’t want to get better. They aren’t thinking properly. It’s why they can’t just “go eat some cake” the way people used to tell me to. And the idea that a treatment provider would just let patients decide to eat or not eat whatever they want, as the physician in the movie does, is pretty unrealistic. It’s definitely not mainstream.
To The Bone doesn’t delve into some of the really serious medical conditions that go along with Anorexia Nervosa. It has the highest mortality rate of any psychiatric disorder, most often due to heart complications like arrhythmias. Patients starting to eat again have to be closely monitored for Refeeding Syndrome. There is bone loss, anemia, cold intolerance, hair thinning or lanugo, vitamin deficiencies, and numerous gastrointestinal problems. It is primarily a psychiatric disorder, but with so many physical consequences.
My mom once told me she would check on me at night to make sure I was still alive, and that breaks my heart. There is guilt. Guilt because having an eating disorder puts a strain on your family and those around you. Financially, emotionally, time – it sucks to become a problem to others. I knew my family would do anything in the world to help me get better, but I hated that I was making them have to. There is very often depression and anxiety underlying the eating disorder, and so therapy is very necessary for full recovery. My anxiety was diagnosed during my eating disorder, but is now well managed thanks to an SSRI and learning better ways of handling stressors.
I could truly go on for ever about this. I am so passionate about educating others about eating disorders in order to remove the stigma. It’s a huge part of why I pursued medical school. And while I am so happy that eating disorders are being given more attention, but it’s tricky at the same time. It’s hard not to cross the line into glamorization. It’s impossible not to be triggering for those still struggling. For those that are still sick, this movie could very likely just be a source of inspiration. The eating disordered brain plays really nasty tricks.
So I’ll close with a reminder to please reach out if you need help. You can email me, tell a friend, talk to your doctor, or use the numerous resources from the National Eating Disorders Association. Please know that you can get better and that you are deserving of getting better. You are beautiful and wonderful and worthy, and life is so, so good on the other side.
More To The Bone Reading…