Art Imitates Life — Imperfectly

In the previous post, we looked at the film “To the Bone” through the eyes of three different critics who are all recovering anorexics. But their take might be unacceptably anecdotal, meaning derived from the personal experience of persons who have actually had the experience.

Fortunately, Psychology Today published a piece by two psychiatrists, Eugene Beresin, M.D., M.A., and Jennifer Derenne, M.D., about why this work of fiction (with roots in its creator’s real life) is so widely criticized. Their article strives to help parents decide whether, and under what circumstances, children should see “To the Bone.”

Medical professionals, teachers, therapists and educators are concerned about its potential cultural impact, specifically that it encourages young people to pursue the anorexic lifestyle. To kids adrift among too many choices it looks enticing, like a secret society with its own language and customs, to which only an elite subset of exceptional people may aspire to belong.

The slangy conversations between the young patients reveal “tips and tricks” for surreptitious weight loss, techniques for hiding certain behaviors from concerned adults, and some glamorization and glorification of eating disorders. Grownups fear that this could prove harmful to diagnosed anorexics who have not yet learned the ropes, and act as a textbook for impressionable kids eager to forge an identity for themselves.

Indeed, before the film was even released, bits of it were showing up on pro-ana websites. But these mental health professionals disagree:

As for concerns about Ellen’s story serving as a “how to” manual or guide to weight loss behaviors, the truth is that much more explicit and detrimental information can be easily found online if someone is actively looking for it.

Ellen, the lead character, is taken by her stepmother to apply for admission to an inpatient facility run by the charismatic Dr. Beckham. The stepmom prides herself on her amateur psychology skills and is totally prepared to explain everything about Ellen’s life and psyche to the expert.

This character is annoying, but some of the film’s many critics point out that in real life, parental attitude and demeanor actually have very little to do with either the disease or the recovery. Drs. Beresin and Derenne remind readers that while family dynamics may contribute, eating disorders also occur in families that are quite supportive and loving. They say:

Eating disorders arise in the context of a “perfect storm” of factors, including biological vulnerability (genetic predisposition, associated mood instability), temperament (perfectionistic, obsessive, and sensitive to rejection), and a societal preoccupation with the thin ideal.

In the meeting with Ellen and her stepmother, a line of Dr. Beckham’s dialogue makes pretty good sense — “Looking for one reason is a losing battle. It’s never that simple.” This is mentioned because it seems to be the only utterance from that character’s mouth that is not picked apart by the haters. These authors say,

Dr. Beckham’s pronouncement, “I’m not going to treat you if you’re not interested in living,” would be unheard of coming from any sound clinician, no less an expert in anorexia nervosa… In short, Dr. Beckham was fostering substandard care, if not outright malpractice.

According to its detractors, the film reinforces caricatures, or at least stereotypes, and does not accurately portray the loneliness and isolation felt by these patients in real life. The relative ease with which the characters connect with each other, are open about their struggles, and are willing to be confrontational is unusual for individuals with eating disorders. A budding romance between two patients with anorexia nervosa in the first weeks of treatment is difficult to fathom.

Okay, but it is a movie. A screenplay obeys conventions different from, but as strict as, those involved in writing a scientific paper. Character development and relationships that would be drawn out over time are necessarily compacted. If only that compression were the biggest problem! This is what concerns the psychiatrists:

Recovery from anorexia nervosa is not solely, or even typically, about “hitting bottom” and finding motivation for change… [T]he film perpetuates the myth that individuals with psychiatric disorders will, at some point, “see the light” and recover due to a single transformative experience. While dramatic and wishful, emotional and behavioral change rarely occurs in this manner.

Your responses and feedback are welcome!

Source: “Two Psychiatrists Weigh in on Netflix’s ‘To the Bone’,”, 07/21/17
Photo credit: Rae Allen on BY

Leave a Reply

Your email address will not be published.

FAQs and Media Requests: Click here…

Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources