Why We All Need to Read Carolyn Costin's Review of To the Bone

Watch this week's recovery video in which I share my thoughts on To the Bone.

Below you can read Carolyn Costin's official review of To the Bone:

"I was hesitant to see the new Netflix eating disorder movie, To The Bone. As someone recovered from anorexia and an eating disorder therapist, author, educator and spokesperson I generally do NOT like eating disorder movies, documentaries, TV specials, “reality shows” or even autobiographical books about eating disorders and tell my patients to steer clear of them. However, when asked by Project Heal to attend the screening and moderate a panel discussion afterward, I agreed.

The film stirred up controversy even before its release and because of its significance as the first major film on eating disorders with the potential to be seen in 100 million homes, I wanted to ascertain the situation for myself. Did To The Bone have something of value or was it going to end up on the “do not watch” list with so many others.

To The Bone is based on a true story about a young woman with anorexia nervosa, and brings viewers into the eating disorder world, including interactions her family, her doctor, and a variety of other patients in a treatment center. The patients are portrayed realistically, without showing gratuitous scenes of behaviors such as wretching into a toilet while at the same time not glamorizing the illness by avoiding anything that could be potentially controversial or disturbing.

This is a film based on what happened in the life of one individual, not a movie about understanding, preventing or treating eating disorders. It’s not meant to educate the public on the causes of the illness, or how best to treat it. It is writer/director Marti Noxon’s autobiographical story (with some artistic license thrown in). Marti felt her story was important to tell in order to raise awareness about a misunderstood subject.

To The Bone will, for sure, raise more questions than provide answers, and that is exactly what Marti had in mind. Her hope is to promote a conversation about an illness that is still not well understood by the public and does not get appropriate coverage or concern.

The film’s main character, Ellen, has anorexia nervosa, from which more people die than any other mental illness, yet no one has taken it seriously enough until now to put resources into a major film. Marti felt compelled to make a film and make a difference and faced many obstacles along the way. For example, several people whom she tried to get interested in the project told her they did not think the eating disorder topic was a big enough issue. She knew, and many of us know, better.

Are there things I dislike about the movie? Yes. Do I think there were unrealistic parts? Yes. Would I have done things differently? Yes. As an eating disorder treatment provider, educator and activist, I wish there ha been more explanations given about the disorder and that the movie had shown more about how treatment helps people recover. I would have included much more and much different therapeutic dialogue and I would not have depicted the eating scenes at the treatment center in the same way.

Much of the controversy surrounding the film comes from the fact that Lily Collins, who played the part of Ellen, also suffered from anorexia as a teen and yet she lost weight to authentically play the role.

I too was concerned and unsettled upon hearing the leading actress had suffered from anorexia in the past yet lost weight to play the part. As a therapist I certainly would not recommend any of my clients do this. But after meeting and talking to the real person, Lily, her mom and Marti, I learned about the care and thinking that went into her decision including the medical and nutritional monitoring that took place. But even that is not the most important thing here. What is far more important is that Lily is fine. Not only did she not relapse, she found the entire experience “insightful” and “therapeutic” learning many things she did not know or understand when she was 16 and suffering from her eating disorder.

To those who express their anger and boycott the film, I wonder what would they suggest as an alternative? As far as I know, no one has yet offered a better solution for Ellen’s character. Should Marti have found an actress currently suffering from anorexia to play the part? Should some other actress have lost weight for the part? Should she have hired a normal weight actress to play the part of someone with severe anorexia nervosa? All of these alternatives would have brought their own problems, concerns and controversies. To avoid all potential problems or criticism, no movie could be made at all.

You can’t make a film about a troubling topic without troubling people. There is no way to deal with a sensitive, disturbing, and difficult subject, such as eating disorders, without upsetting or “triggering” a sub set of individuals most closely associated with the issue, whether professionals, patients or their families. If no one was disturbed by this film, there would indeed be something terribly wrong. Eating disorders are disturbing, confounding illnesses. Would I advise patients to go, no, they don't need to see it, they already know what the movie is trying to reveal.

The other controversy has so far sprung from those who have seen the trailer and complain that showing a white skinny girl is not fully representative of the spectrum of eating disorders and the scenes might be triggering for those who are vulnerable or already suffer from the illness.

They are right. However, the trailer is not representative of the movie. The movie portrays 7 patients with varying diagnoses, body shapes, gender and color. Particularly arresting is Alex Sharp’s portrayal of the male patient, Luke.

Will the trailer and the film trigger some people, yes, but I found this film less potentially triggering than most. The trailer shows perhaps one of the most triggering scenes of the film. But you can’t make a film about eating disorders without upsetting or triggering some people. During my own eating disorder just watching someone in a movie eat, get on a scale, go on a diet, or work out at a gym was triggering. Any program, of any kind, about eating disorders will trigger some and that will be the case withTo The Bone, but not such that is loses all value which will be as diverse as the people who go to see it.

With my 40 year history in the eating disorder field, I am passionate about anything that can be done to help understand, prevent and treat these illnesses and even though To The Bone has weaknesses and is not the movie I would make, it is still an important step in bringing eating disorders front and center. I can put aside my own biases both as someone who recovered and as a current expert in the field and see this movie for what it is, one woman’s story that is authentic, sad, realistic, disturbing, scary, and true. And as for hopeful, let me just say that the real Ellen, Marti Noxon, is recovered and here to say it is possible and that speaks volumes." - Carolyn Costin, July 14, 2017

Carolyn Costin - Angie Viets

Carolyn Costin, MA, MEd., MFT, CEDS, FAED, is a world renowned, highly sought-after eating disorder clinician, author, and international speaker. In her twenties, Carolyn recovered from anorexia and became a teacher and a psychotherapist. After successfully treating her first eating disorder client in 1979, she recognized her calling. In 1996, she created Monte Nido, the first licensed, residential eating disorder treatment facility in a home setting. Having left Monte Nido in 2016, Carolyn maintains her private practice and remains very active in the eating disorder field lecturing, training, teaching, writing and supervising. In 2017, Carolyn founded The Carolyn Costin Institute, which offers Eating Disorder Mentor and Coach Training, online and in-person Continuing Education for clinicians, and other specialized trainings.

Should You Watch 'To The Bone'? A Yoga Therapist Shares Her Hopes and Concerns About The Movie

Photo Credit: Netflix

Photo Credit: Netflix

When pictures and trailer clips of a disturbingly thin Lily Collins began to show up in my news feed the other week, I resolved to avoid the movie To The Bone and all discussions about it. I wasn't going to watch the trailer, read about the movie, comment about it on social media, or write a blog post about To The Bone, the first motion picture about eating disorders due out in the US on July 14 on Netflix. I was determined to sit this one out and wait for the buzz to pass.  

Collins plays a severely anorexic teenager named Ellen, and when I say "severely anorexic," I am not exaggerating. She's a haunting figure, barely there. She is painfully ill and her body is painful to take in. Even now, writing about her, I feel a pit in my stomach--a raw visceral reaction that comes from a sincere concern for the actress, the memory of and deep care for the women with whom I have been in treatment, and from an honest and personal knowing about the life she portrays in the film. Also unsettling for me is the fact that Lilly has a history of anorexia and bulimia. And now, here she is, as sick as can be again, reliving anorexia. For all these reasons, I was set on not getting caught up in To The Bone. I just couldn't see how this movie and the hype around it would support me in my life.

Low and behold, the very next day after explaining all of this to a friend, I received an email from The Renfrew Center of Philadelphia, asking me to appear as an alumna on a local news station with Samantha DeCaro, PsyD, Assistant Clinical Director at Renfrew to discuss my reaction to the 3-minute trailer for the film. Of course, I was excited (exhilarated really) and quite touched Renfrew invited me to do this. How could I not be? And I am grateful they did, because it turns out I do have some important things to say about the trailer, and I am actually a better woman, mother, yoga therapist, and member of the eating disorder recovery community for speaking out. 

In the less than 48 hours I had to prepare for my 3-minute interview on Fox29, I watched the trailer several times, read articles about the film and its director and lead actress, had a heart to heart with my husband, and put out an inquiry on social media, asking people to tell me about their thoughts, opinions, and concerns about the trailer for To The Bone.

After hearing back from so many people, I felt secure in my initial reaction to avoid the film. Many people had similar responses to Collins' physical appearance. More than that, they were deeply disturbed that the actress has a history of anorexia and bulimia and reported she lost weight in a "healthy" way for the film. Like the others who wrote to me, I am very worried about the message this sends to the recovery community as well as teens and others who are vulnerable to messages about weight loss and the connection between one's self-worth and jeans size. After more than 20 years of healing from anorexia, I can say with confidence, that it is highly not possible to lose weight in a "healthy" way. And there is clearly nothing healthy about Collins' body, and I am worried about the state of her mind after embodying this role in such a dramatic way. 

Based on the trailer, anorexia is clearly front and center. I am concerned that anorexia has become the face of eating disorders in the media. The "thin ideal" has glamorized the disease, making it a one-dimensional disease about weight and food. I am hopeful (fingers and toes crossed) that To The Bone will give voice and attention to other types of eating disorders and that other bodies, genders, races, and a spread of ages will be represented. To exclude these bodies and voices would be a severe shortcoming on the part of the film and an enormous disservice to the eating disorder community, including the families and supports of those who struggle.

I am also hopeful that the movie will portray the complexity of eating disorders as well as capture the resiliency that is possible with proper treatment and dedication to one's healing. The joke in the trailer about "calorie Aspergers" is offensive, and not one appreciated by several of the people I corresponded with on social media. In the context of the movie, it may work. But as a one off, it makes me wonder if the complexity of anorexia will be brought to light. 

Another concern is that the movie's ending will suggest that Ellen gets to go home cured. This just isn't the case in real life, and to give families and supports such false hope could be devastating for all parties involved. Let's hope that recovery isn't itself glamorized as a mountain that is conquered after a few weeks or months away at treatment.

Although I value Collins' lived experience and dedication to her career and mission to, I am concerned that To The Bone will fall short in its efforts to accurately educate. I worry it will trigger many and even set off a desire to be "sicker" in others. Still, I am hopeful that this film will initiate important conversations about eating disorders and their prevention and treatment. I am hopeful that the recovery community will come together with honest feedback about whether or not a motion picture in the first place is helpful. As my husband shared with me, a documentary is much more humane and real; let the individuals who are living it share in real time about their experiences.

There are many more concerns and hopes I have about To The Bone, but I want to turn this blog post over to you now. I'd like to hear your thoughts and opinions about the trailer. Please share in the comments below or email me. It's only from learning from one another that we can grow stronger in our voice and more confident in our right to use it!

Sadly, the video clip of my interview is currently unavailable. Should it become available, this post will be updated!

Jennifer Kreatsoulas - Angie Viets - To The Bone Movie

Jennifer Kreatsoulas, PhD, RYT 500 is the founder of Chime Yoga Therapy and specializes in eating disorders and body image. In addition to her private yoga therapy practice, Jennifer leads yoga therapy groups at the Monte Nido Eating Disorder Center of Philadelphia, is cofounder of the Body Kindness Project, and a partner with both the Yoga and Body Image Coalition and the Transformation Yoga Project. She is the creator of the home video series Yoga to Strengthen Body Image and Support Eating Disorder Recovery. Her writing on the topics of yoga, body image, motherhood, and eating disorder recovery can be found on her blog as well as several influential online publications.  Connect with Jennifer.