A Former Eating Disorder Counselor’s Thoughts On ‘To The Bone’

As I sank into my blue plushy couch watching “To the Bone” with my husband Tuesday night, two simultaneous thought loops ran through my head.

I have an undergrad English degree. I’m a writer. I love the narrative arc, carving words out of dust, and that indescribable high of reading through a polished piece that began as thoughts bouncing around in your head. I call this my writer brain.

I am also a doctoral student in Clinical Psychology. I worked in a residential eating disorder treatment center and research lab for two years. I call this my science brain.

My entire world is English and Psychology, intersected. The way I explain it to people is that it’s a relentless obsession with the human narrative. As I was watching the movie unfold, I could not separate the two.

The movie was narratively brilliant. It told a complex story in an incredibly nuanced way. It described the behaviors and minutiae of an eating disorder and treatment centers from a true insider’s perspective. The vomit bag underneath the bed. The working out at night behind closed doors. The bruised back from sit-ups. The compulsive body checking, particularly around her upper arm. All details I’ve witnessed firsthand that I’ve never seen depicted on screen with such precise accuracy.

I was also incredibly struck by Ellen’s flippant, in-your-face defiance. The going to treatment center after treatment center to appease her parents, all while flipping a figurative bird to the world and continuing to drop in weight. The near unbreakable alignment of Ellen with her eating disorder, her second degree gain from being so sick. It takes a near brush with death to pull her out, as it does for so many. She reminds me of past acute clients my heart has truly ached for, wishing more than anything I could make them care enough to fight for their lives.

It was also highly inaccurate in some ways. Yes, therapists are given license to do therapy in an individualized way they feel is beneficial to their clients. But there are guidelines. Treatment centers have to operate in a way that is somewhat evidence based, otherwise they simply wouldn’t get referrals or insurance carrier support. Having clients eat alone and do incredibly triggering things in front of each other is not an evidence-based form of therapy.

They are in treatment because they are not high functioning enough to be at home. What is their insurance paying their expensive treatment bills for if they are not getting any kind of meal support or guidance?

Also, there was no dietitian or any kind of meal plan in sight in the movie. One of the biggest parts of ED recovery is working with dietary support. Dietitians differ somewhat on the how and how often they intervene, but having a dietitian at all, particularly in terms of inpatient/residential recovery, is fairly non-negotiable.

In trying to find a conclusion to my thoughts, I am reminded of a Dialectical Behavioral Therapy skill I loved to use with past clients, called Either/Or vs. Both/And. When stuck in black and white thinking, it can seem like things have to be either one or the other. To the Bone is either a terrible movie or a great movie. It’s either helpful or unhelpful for those in recovery. You have to see it because it’s so amazing, or you should not see it because it’s so triggering. But the truth, as always, lies somewhere in the middle. It is both narratively intriguing and highly triggering. It is at times therapeutically inaccurate, and yet still portrays therapy in way that feels intimate and real. There are compelling things about it to watch, but at the same time, if in recovery you should seriously think about whether it would be helpful or harmful for you and your personal recovery.

Everyone’s answer is going to be different, because no one recovery is the same.