A Therapist's Opinion on TV Show "To The Bone"

[magpie]

I haven't seen the show this article references but I thought this might open up an interesting conversation about calls for media censorship regarding mental health topics. The show is based on the writer/director's life experiences with her eating disorder.

As An Eating Disorder Therapist, I’m Concerned About Netflix’s ‘To The Bone’ | HuffPost

Interestingly this article was written by a therapist and she makes a number of claims.

Claim #1: It is never healthy for anyone with a history of anorexia to attempt to lose weight.

Lilly Collins, who says that she recovered from anorexia herself, has appeared in press interviews for the movie where she discusses how she lost weight for the role “in the most healthy way possible,” with the help of a nutritionist.

It was difficult for me to even type that sentence. Saying that someone with a history of anorexia is able to “lose weight in a healthy way,” is akin to sharing that an individual with a history of alcoholism is able to “drink in a healthy way.” It’s just not possible and frankly it’s an incredibly irresponsible message to share, as it could be highly triggering to someone in recovery from an eating disorder.

Let me make one thing clear, there is no such thing as purposeful “healthy weight loss” for someone with a history of anorexia. Even if an individual’s intention is to do it “in a healthy way” (whatever the heck that even means?!) they have underlying genetic and temperamental factors for a life-threatening mental illness, which can be activated by energy deficit and weight loss (regardless of what the intention behind this is).

Claim #2: Media shouldn't depict eating disorder behaviours because it might encourage someone with an eating disorder. It's best to just pretend it doesn't exist.

The problem with depicting a story that details someone’s struggle with an eating disorder is that it can quickly become a “how to” manual for those who are already struggling or have the underlying genetic predisposition towards an eating disorder.

The trailer discusses specific calorie counts of foods, depicts an actress that appears highly emaciated, and displays eating disorder behaviors, such as compulsive exercise, restriction, and triggering messaging i.e. the actress stating, “I’ve got it under control.”

As an eating disorder specialist, I can tell you that eating disorders are often “competitive illnesses.” Individuals in recovery who view this film could easily use it to continue to fuel their eating disorder.

Claim #3: It is detrimental to cast someone in the part of a character with an eating disorder unless they can represent all affected populations at once. Otherwise, people might become confused that they have an eating disorder while someone different than them on TV has an eating disorder.

Further, the trailer reinforces stereotypes and myths about people who have anorexia. It’s depiction of someone with anorexia as an emaciated, Caucasian, young female, who is starving herself to “feel in control,” is not representative of the variety of people impacted who struggle with this disease.

First off, while the desire to feel “in control” might be one aspect of an individual’s struggle with anorexia, it’s important to highlight that eating disorders are caused by a combination of genetic, temperamental, and psychological factors, which are then triggered by environmental stressors. Depicting anorexia as a desire to be “in control” or to “look like a model,” perpetuates the myth that people are simply “making a choice,” rather than struggling with a serious mental illness.

Additionally, eating disorders do not discriminate based upon age, gender, or race. In my practice, I have worked with teens and adults, men, women, transgender individuals, as well as people of diverse races and ethnicities.

It is also often hard for those with anorexia to recognize that they are struggling with the disease, as “the eating disorder self” will often tell them that they are not. There already is this pervasive cultural narrative that anorexia mainly impacts young, white, Caucasian, females. Therefore, I’m worried that someone who is struggling with doesn’t meet these narrow criteria might not seek help, as they believe that they couldn’t possibly have an eating disorder.

Also, eating disorders (including anorexia) can impact people across the weight spectrum. It’s important to note that you do not have to appear emaciated, like the lead actress in the film, to be struggling with anorexia. This dangerous myth can cause people to avoid seeking life-saving treatment, as they might believe that they are “not sick enough” to get help.

Claim #4: It isn't right to cast a thin person as an anorexic character because it doesn't represent fuller figured people who have binge eating disorder or bulimia. (The diagnostic criteria for anorexia is an underweight BMI.)

You cannot tell who is struggling with an eating disorder by looking at them. Eating disorders are one of the few mental illnesses, where we judge someone’s “level of suffering” based on their physical appearance. This is not ok. Someone can be seriously struggling with anorexia-at any size. No matter what your weight is, if you are struggling with an eating disorder, you deserve to seek treatment and help.

It’s also important to note that there are a variety of other eating disorders, including binge eating disorder, bulimia, and OSFED, all of which are serious mental illnesses. However, unfortunately these eating disorders are not as frequently discussed in the media. No matter what eating disorder you struggle with, you deserve to get support and treatment.

What do you think of her claims?

 

[Smilephantomhive]

People have the right to make whatever tv show they want. "To the Bone" may trigger anorexia, but if you ban that, then everything else will have to be banned because anything could become a trigger. I guess it's a slippery slope thing. Maybe they should just put a warning on the show.

People said the same thing with "Thirteen Reasons Why", and I didn't agree with censorship then either. For that show people claimed that it was glorifying suicide, but it didn't seem like it romanticized killing yourself at all. I then came to the conclusion that they think it glorifies suicide becuase they are suicidal themselves, and are looking at things through that lens.

Warnings instead of censorship are probably the best solution. This is where I think friends could help out, by maybe trying to encourage their anorexic friend to watch a different show. But of course not everyone knows of their friend's mental health issues or takes them seriously, so idk.

 

[Mole]

What do you think of her claims?

Freak shows used to travel around in the circus, and we would all go down to see the freaks, who usually were physically deformed. But with the advent of television, we sit in our lounge chairs to see the freak show, which is now psychological rather than physical.

And as we now live in the therapeutic society, we tend to identify with those with psychological problems, we are narcissists who see ourselves in everything, particularly those freaks with psychological problems.

And how interesting, it is now politically incorrect to gawk at physical deformity but we can gaze on and judge psychological deformity. And indeed it is politically incorrect to call it a deformity. What we say is that we are all psychologically challenged, so we are all psychologically normal.

 

[Siúil a Rúin]

She may be correct that a program about eating disorder would have a negative influence on people struggling with that issue. It is a difficult issue though, because I do think that there are plenty of other sources of inspiration to negatively influence eating disorders. If someone with an eating disorder is inclined towards seeking out a role model for admiration, they easily find them in the media, but a program like that will likely have a negative contribution for some. (I haven't seen the program so am only speculating)

It is an interesting inconsistency between the diagnostic criteria of low BMI and what this therapist says about any body weight being associated with anorexia. From a logical standpoint I would tend to reconcile that with the idea that anorexia can begin at any body weight, and may be combined with other eating disorders to create inconsistency in terms of calorie intake. If someone purely has anorexia for an extended period, then I would expect that eventually there would be evidence of weight loss.

It is likely that a program will over simplify the issues of a complex psychological issue like an eating disorder. There are also so many variants of eating disorders and not just the official categories. It can be very different for each person. It would be a significant challenge to represent the entire spectrum of it.

I'm not really saying anything conclusive except that the therapist could have a point, but I don't necessarily think that means the show has to be censored. Anorexic people do have to live in a world with complex input from various sources and there is a wide range of causes for these conditions.

 

[Siúil a Rúin]

I may try to watch the show to get a sense of it. I just watched the trailor and would have to say it seemed emotionally very odd. I'm not certain how to put it into words, but it felt disjunct from the subject matter. It might have been the background music, so I'd be curious to give the show a chance. I've read about anorexia for a long time, because it's something that resonates a bit. I would like to hear how people who have recovered from anorexia might react to the show. The idealized famous models and actresses who are super skinny are likely the strongest influence because they represent the cultural ideal. There are some excellent youtube clips of young girls who survived anorexia and now try to help. One is going to become a psychologist.

 

[magpie]

I may try to watch the show to get a sense of it. I just watched the trailor and would have to say it seemed emotionally very odd. I'm not certain how to put it into words, but it felt disjunct from the subject matter. It might have been the background music, so I'd be curious to give the show a chance. I've read about anorexia for a long time, because it's something that resonates a bit. I would like to hear how people who have recovered from anorexia might react to the show. The idealized famous models and actresses who are super skinny are likely the strongest influence because they represent the cultural ideal. There are some excellent youtube clips of young girls who survived anorexia and now try to help. One is going to become a psychologist.

The interesting thing about this show is that it is based on the writer and director's own personal life experience and struggles with anorexia. The actress who plays the main character also has a history of anorexia and brings her own experiences to the table for her performance. This show was made with the intention to honestly reflect the struggles of the people who made it and as a way to tell their own stories. The backlash against it from mental health workers in particular seems more like an attempt to silence survivors from educating the world about their struggles and sharing their experiences. In my opinion the attempt at silencing people with mental illnesses from having a platform to share their experiences is done under the guise of concern for vulnerable people in the population. I've encountered a lot of mental health workers that hold a mindset of not wanting the "crazy" to spread and who fear mentally ill people being given platforms. I think though that this type of show is exactly what the population at large needs and also, the people who made it deserve the opportunity to tell their stories as much as anyone else. People who struggle with eating disorders don't have to watch it. The job of a storyteller is to tell an honest story, not to dilute it with attempts at making it palatable to everyone in the population.

 

[Siúil a Rúin]

I'll add that even though I was never anorexic, three times I've had a weird eating dysfunction where I lost to ability to eat for a couple of months and had to force myself due to anxiety. While I had some body dysmorphia, it was never organized as "I'm overweight, so I'll stop eating to get thin". It was more like I just felt horrifically ugly and was too stressed out to eat. I also started going on extensive walks and bike rides, not with a goal, but just from anxiety, so I'd lose like 20lbs in a few weeks doing that. My stomach and throat would shut down so it 'couldn't' swallow. I remember when it happened after I graduated college I went to a pizza party and couldn't eat the pizza even though I was intensely hungry. I can't explain it except my stomach felt like a brick and I couldn't swallow. I got home and cried for an hour. I'm 5'5" and would typically get down into the 90+lbs area during those three scenarios.

Perhaps because of those experiences I don't associated eating disorder with the kind of positive happy feeling in the trailor for the show. It felt so dark and nervous and tense that I don't connect it with upbeat music or smiles. I also realize (like I said before) that eating disorders are varied, so maybe the high energy party feeling is part of it for some people? It felt a little like there was an emotional edge missing that shows the inner pain of it.

The interesting thing about this show is that it is based on the writer and director's own personal life experience and struggles with anorexia. The actress who plays the main character also has a history of anorexia and brings her own experiences to the table for her performance. This show was made with the intention to honestly reflect the struggles of the people who made it and as a way to tell their own stories. The backlash against it from mental health workers in particular seems more like an attempt to silence survivors from educating the world about their struggles and sharing their experiences. In my opinion the attempt at silencing people with mental illnesses from having a platform to share their experiences is done under the guise of concern for vulnerable people in the population. I've encountered a lot of mental health workers that hold a mindset of not wanting the "crazy" to spread and who fear mentally ill people being given platforms. I think though that this type of show is exactly what the population at large needs and also, the people who made it deserve the opportunity to tell their stories as much as anyone else. People who struggle with eating disorders don't have to watch it. The job of a storyteller is to tell an honest story, not to dilute it with attempts at making it palatable to everyone in the population.

I'll definitely be interested to watch it knowing all of that. The trailor isn't enough to know what it will be like.

 

[Smilephantomhive]

I'll add that even though I was never anorexic, three times I've had a weird eating dysfunction where I lost to ability to eat for a couple of months and had to force myself due to anxiety. While I had some body dysmorphia, it was never organized as "I'm overweight, so I'll stop eating to get thin". It was more like I just felt horrifically ugly and was too stressed out to eat. I also started going on extensive walks and bike rides, not with a goal, but just from anxiety, so I'd lose like 20lbs in a few weeks doing that. My stomach and throat would shut down so it 'couldn't' swallow. I remember when it happened after I graduated college I went to a pizza party and couldn't eat the pizza even though I was intensely hungry. I can't explain it except my stomach felt like a brick and I couldn't swallow. I got home and cried for an hour. I'm 5'5" and would typically get down into the 90+lbs area during those three scenarios.

Perhaps because of those experiences I don't associated eating disorder with the kind of positive happy feeling in the trailor for the show. It felt so dark and nervous and tense that I don't connect it with upbeat music or smiles. I also realize (like I said before) that eating disorders are varied, so maybe the high energy party feeling is part of it for some people? It felt a little like there was an emotional edge missing that shows the inner pain of it.


I'll definitely be interested to watch it knowing all of that. The trailor isn't enough to know what it will be like.

I bet many will watch is because that one else psychologist didn't like it! Including me lol.

 

[Mole]

The interesting thing about this show is that it is based on the writer and director's own personal life experience and struggles with anorexia. The actress who plays the main character also has a history of anorexia and brings her own experiences to the table for her performance. This show was made with the intention to honestly reflect the struggles of the people who made it and as a way to tell their own stories. The backlash against it from mental health workers in particular seems more like an attempt to silence survivors from educating the world about their struggles and sharing their experiences. In my opinion the attempt at silencing people with mental illnesses from having a platform to share their experiences is done under the guise of concern for vulnerable people in the population. I've encountered a lot of mental health workers that hold a mindset of not wanting the "crazy" to spread and who fear mentally ill people being given platforms. I think though that this type of show is exactly what the population at large needs and also, the people who made it deserve the opportunity to tell their stories as much as anyone else. People who struggle with eating disorders don't have to watch it. The job of a storyteller is to tell an honest story, not to dilute it with attempts at making it palatable to everyone in the population.

Anorexia is one of the more lethal diseases. It is both psychological and physical. And those in the grip of the disease justify it and valorise it and seek to recruit others. And those who have the disease wish to feel normal and so seek to normalise the disease. And unfortunately Americans are so open minded they think anorexics have the same right to spread their disease as anyone else. It's a mistake.

American tobacco companies think they have the same right to spread their addiction as anyone else. And the American Rifle Association think they have the same right to spread guns as anyone else. And along with anorexics, what American tobacco companies and the American Rifle Association are spreading, is lethal.

 

[magpie]

Anorexia is one of the more lethal diseases. It is both psychological and physical. And those in the grip of the disease justify it and valorise it and seek to recruit others. And those who have the disease wish to feel normal and so seek to normalise the disease. And unfortunately Americans are so open minded they think anorexics have the same right to spread their disease as anyone else. It's a mistake.

American tobacco companies think they have the same right to spread their addiction as anyone else. And the American Rifle Association think they have the same right to spread guns as anyone else. And along with anorexics, what American tobacco companies and the American Rifle Association are spreading, is lethal.

What if Goethe hadn't been given the "right" to spread his neurosis? Maybe there wouldn't have been a bunch of copycat suicides from people reading The Sorrows of Young Werther. Suicide is, after all, both psychological and physical. So if back then, we had tried to say Goethe had no right to spread his disease and we censored his books, a few lives may've been saved, but art would've suffered. Without neurosis there is no art, without art there is no culture, and without culture there is no civilization.

Would you censor civilization?

 

[Siúil a Rúin]

I think this show will generate more discussion about anorexia, which could have a positive impact on the issue. I wouldn't censor or cancel the show, but I think people have a right to criticize it. The trailor does *feel* like 'super happy fun time', and that might be because it is being set into the generic new show template. It is how all new shows are presented, but it creates an emotionally incoherent sensibility. The lead character is very cute, even super skinny, she smiles a lot, exudes plenty of energy, and I think many junior high school girls will want to be exactly like her. It's true that adrenaline kicks in without calorie intake, but there are also lots of times of crashing in exhaustion, so you can't jump and dance around all the time like we see in the trailor. There might be some who are also helped by the show, and right now I really don't know the details of how they are going to address the issue.

This is a touching video about a young girl who survived anorexia and plans to become a psychologist to help other people with anorexia. I know it isn't a show/drama, but it maintains a clear emotional communication about it. Teen Anorexia Survivor Wants To Help Others Battle Eating Disorders - YouTube

Edit: I just revised the link for the entire clip. The other was shortened I think.

 

[Mole]

What if Goethe hadn't been given the "right" to spread his neurosis? Maybe there wouldn't have been a bunch of copycat suicides from people reading The Sorrows of Young Werther. Suicide is, after all, both psychological and physical. So if back then, we had tried to say Goethe had no right to spread his disease and we censored his books, a few lives may've been saved, but art would've suffered. Without neurosis there is no art, without art there is no culture, and without culture there is no civilization.

Would you censor civilization?

Druggies use this same argument to valorise the criminal use of drugs. Drugs we are told are used for a higher purpose, but once you get to know druggies you know that drugs are the higher purpose, and they want to pull the wool over our eyes.

On this very site we have members in good standing who want to have sex and drugs with young teenagers, even though we know this damages the psyches of young teenagers on the cusp of puberty.

 

[Siúil a Rúin]

[MENTION=3325]Mole[/MENTION]
Isn't it only comparable to drug promotion if people are making a disorder appealing and encouraging the behavior? Hopefully this show, and certainly others, are trying to increase awareness so that people don't exacerbate the problem of eating disorders by making statements like "well that's natural selection if they get triggered" implying that people deserve to get sick or die if they have a mental illness, the root of which results from powerful environmental and chemical influences.

I do appreciate the foundational point that [MENTION=22178]magpie[/MENTION] is making when she states that people with mental illnesses and emotional issues deserve to speak out and tell their story and to not be hushed by society because what they say isn't pretty and doesn't work on an inspirational poster. I have a lot to say artistically about emotional trauma and pain, but absolutely feel that stifling effect. I feel concern that people will misunderstand it as promotion, or that employers could even fire me to talking about such horrible things in my art. Instead society makes us all feel like all we can say is stuff like "think positive and you'll get everything you want'. Or "Hang in their baby, you'll be fine." There is a tremendous amount of dismissal, and yes, it is complicated because people interpret information all different ways. There are people that copy behaviors without thinking about consequences, so it is possible to make a stand against a destructive behavior and have people hear you, but then start doing it instead of understanding the warning.

This is because a lot of human beings have self-destructive issues, but that also makes it more important to talk about these self-destructive issues and figure out how they start, how they get triggered, and how to stop them. They are incredibly powerful and the case of anorexia is especially powerful because it can distort perceptions and it can result in death. Someone needs to talk about it and not just put expensive clothes on it and have it walk down the catwalk as some kind of unobtainable cultural ideal.

 

[magpie]

Druggies use this same argument to valorise the criminal use of drugs. Drugs we are told are used for a higher purpose, but once you get to know druggies you know that drugs are the higher purpose, and they want to pull the wool over our eyes.

On this very site we have members in good standing who want to have sex and drugs with young teenagers, even though we know this damages the psyches of young teenagers on the cusp of puberty.

Art is the most powerful legal drug, and unlike illegal drugs, it is beneficial to the human psyche. Aristotle coined the term "catharsis" in his Poetics in 335 BC. The Ancient Greeks understood that viewing human suffering in the form of stories allowed the audience to identify with the characters and experience emotional release brought about by the character's circumstances all while safely spectating an imaginary story.

 

[Siúil a Rúin]

This discussion also brought another thought to my mind. To what extent does an artist or any person have some right to tell their own story, however flawed or broken they are as a person, without carrying the entire weight of its effects on humanity? Is there room for someone to just describe their own existence and pain without the idea that they have a goal or agenda to either convince everyone else that it's 'good' or 'bad'?

I see someone like Sylvia Plath doing exactly that. She suffered from a lot of emotional pain, mental illness, and eventually suicide, but maybe she was just telling her story and trying to live her life without being evangelical for or against the nature of her experience?

 

[magpie]

This discussion also brought another thought to my mind. To what extent does an artist or any person have some right to tell their own story, however flawed or broken they are as a person, without carrying the entire weight of its effects on humanity? Is there room for someone to just describe their own existence and pain without the idea that they have a goal or agenda to either convince everyone else that it's 'good' or 'bad'?

I see someone like Sylvia Plath doing exactly that. She suffered from a lot of emotional pain, mental illness, and eventually suicide, but maybe she was just telling her story and trying to live her life without being evangelical for or against the nature of her experience?

You might be interested in reading the play The Pillowman by Martin McDonagh. It touches on a lot of the questions you're asking here. It is a very violent play, just as a warning, so I don't know if it would be your cup of tea.

 

[magpie]

This discussion also brought another thought to my mind. To what extent does an artist or any person have some right to tell their own story, however flawed or broken they are as a person, without carrying the entire weight of its effects on humanity? Is there room for someone to just describe their own existence and pain without the idea that they have a goal or agenda to either convince everyone else that it's 'good' or 'bad'?

I see someone like Sylvia Plath doing exactly that. She suffered from a lot of emotional pain, mental illness, and eventually suicide, but maybe she was just telling her story and trying to live her life without being evangelical for or against the nature of her experience?

I want to write my thoughts about this. Everyone has an intrinsic right to tell their story by nature of existing but no one has the right to force others to listen to them. I don't know if there is much room in the world as it is for people to simply tell their story with no attached agenda except to be able to tell it. But there could be. Everyone has an agenda in their telling though. An agenda to be heard is an agenda. And an agenda to influence people's opinions is not necessarily a bad agenda. In fact, it would be impossible not to have that as an agenda because inherent in your story is your point of view and your own judgements of your experiences. That can't be separated and shouldn't have to be.

Sylvia Plath had a point of view. It's most apparent in her poem Lady Lazarus, where she compares doctors to nazis. I'm not sure how well people pick up on that but it is incredibly apparent to me because of similar experiences leading me to a similar point of view. She could be accused of idealizing mental illness. She could be accused of frightening people away from mental health services by referring to doctors as nazis. And obviously she could be accused of inappropriately referencing the Holocaust. But it was her art and it was her and it was sincere and true to her experiences. So how could it be wrong?

There is a charge

For the eyeing of my scars, there is a charge
For the hearing of my heart——
It really goes.

And there is a charge, a very large charge
For a word or a touch
Or a bit of blood

Or a piece of my hair or my clothes.
So, so, Herr Doktor.
So, Herr Enemy.

I am your opus,
I am your valuable,
The pure gold baby

That melts to a shriek.
I turn and burn.
Do not think I underestimate your great concern.

I think it's easy to find a moral dilemma when you think of art as more than just someone's experiences. Certainly it can have great influence on society as a whole, sometimes for the better and sometimes for the worse. Sometimes for both. But it exists. That story, that life, exists. And so it's already a part of the world.

What I like about The Pillowman is that it's hard to come to any specific conclusion about the morality of it. Certainly Katurian wrote horribly gruesome stories. But is that wrong? He wrote as a reflection of his own trauma. He was not capable of doing anything else. He had to express his life over and over again in different ways and that's all he wanted to do. That's all it was. He was a bad person maybe, a self righteous one certainly, but he was a person and this was his life.

 

[magpie]

I've also seen The Bell Jar condemned for making suicide "seem logical."

 

[Mole]

Art is the most powerful legal drug, and unlike illegal drugs, it is beneficial to the human psyche. Aristotle coined the term "catharsis" in his Poetics in 335 BC. The Ancient Greeks understood that viewing human suffering in the form of stories allowed the audience to identify with the characters and experience emotional release brought about by the character's circumstances all while safely spectating an imaginary story.

Psychotics like Carl Jung are out of touch with reality, and will defy reality by saying things like art is the most powerful legal drug when the reality is that art is not a drug, art is not a substance, legal or illegal.

At best we can say art is a drug is a metaphor, it is not literally true.

 

[magpie]

Psychotics like Carl Jung are out of touch with reality, and will defy reality by saying things like art is the most powerful legal drug when the reality is that art is not a drug, art is not a substance, legal or illegal.

At best we can say art is a drug is a metaphor, it is not literally true.

Yes, it was a metaphor, and most neurotics will take metaphors literally.