Hi, friends! 
   So there has been a lot of hype about the Netflix movie To The Bone. If you haven't heard about it, click here to see the trailer. This film is about eating disorders, or more specifically, anorexia nervosa. Since I'm the friendly, neighborhood intersectional feminist as well as the friendly, neighborhood art therapist, I thought I'd watch it and give y'all my two cents. The three things I'm mainly going to look at are race, class, and gender. Additionally, I'll talk a little bit about successes and failures of the film as well as implications. And sprinkled throughout will be my thoughts as a therapist who works with people diagnosed with eating disorders. Obviously don't read this if you want to watch the film for yourself. I'm totally going to give away the ending so consider yourself warned! 

   Before I dive in I'm going to include some resources. If you or someone you know needs support due to dealing with an eating disorder, you are not alone. You can call the NEDA (National Eating Disorder Association) help line at 1 800 931 2237. If you aren't really a phone person (I'm not), NEDA has a click-to-chat option. Click here. Additionally, there is a crisis text line where you can text with a therapist. Text "start" to 741 741.

   So, just to start out let's be clear that all not eating disorders mean anorexia. This association makes people with other eating disorders pretty invisible. That's really not okay. The DSM-5 recognizes MULTIPLE eating disorders. The classic ones that everyone knows are anorexia and bulimia, but there is also binge eating disorder, feeding or eating disorders not elsewhere classified (abbreviated OSFED, equivalent to EDNOS, eating disorder not otherwise specified in DSM-IV), PICA, and avoidant/restrictive food intake disorder or ARFID, and orthorexia. For more information on types of eating disorders and specific criteria, click here or consult a copy of the DSM-5. 

    

 Race 
   Not surprisingly but not any less disappointingly, the film does a pretty terrible job in the race department. There are precisely 4 people of color and they are all in supporting roles. The roles are as follows: a Latina woman is a housekeeper (obviously), a black woman who is a therapist and has less than 3 lines, a black woman who is a direct care staff person at a treatment center, and a young black girl who is a patient at the treatment center. Of the seven patients in the treatment center, 6 are white and 6 are female. Let's be very clear here. Eating disorder are 13% of women of 50 years old (source) and a harrowing FIFTY PERCENT of girls of color (source). Do we see either women over 50 or women of color represented here? No! The one person of color with an eating disorder is a bigger black girl who has binge eating disorder. This is pretty racist. Obviously women of color have eating disorders and obviously they don't just have binge eating disorder. Anybody who is woke will recognize that it's not accident that the only black patient in the film has binge eating disorder. And the black person with the biggest role is a direct care staff person. Direct care are pretty low on the totem pole in a treatment center. God forbid the psychiatrist or primary therapist be black, latina, asian, native american, or middle-eastern. (The psychiatrist and primary therapist were both white, and the psychiatrist was, you guessed it: a white man). 
    According to NEDA (the National Eating Disorder Association), exact statistics on the prevalence of eating disorders among women of color aren't available due to our historically biased view that eating disorders only affect white women. Relatively little research has been conducted utilizing participants from racial and ethnic minority groups. However, analysis of the Minnesota Adolescent Health Study found that dieting was associated with weight dissatisfaction, perceived overweight, and low body pride in all ethnic groups (source). 
    All in all, looking at race in this film is disheartening to say the least. I'm not sure it's any worse than any other film made by white people but that's not really praise. Aren't we trying to do better? 

 Class 
    As NEDA has observed and many of us can attest to, it's not just rich, white women who have eating disorders. It's actually not just rich women, and not even just women. We'll get to the gender stuff shortly. Anyway, there's a societal perception that eating disorders only affect privileged women. This simply isn't true and it's harmful for at least two reasons that I can think of, and maybe others that I haven't thought of. Reason 1: What purpose does it serve to categorize something as only affecting rich, white women? Are they not worth saving? Are they not worth living without a disorder that ruins lives? Reason 2: If eating disorders are "rich, white woman's disease" what does that mean for men and people of color with eating disorders? Do they now have to bear the shame of having a mental illness but also have a "white" illness? Do y'all see what I'm saying? It's simply further stigmatization in general to continue to view eating disorders in such a limited capacity. Let me be very clear here: I fully acknowledge that white women have not only participated but initiated racism and stigmatization against women of color and I do not condone that. But the point is no one deserves to suffer, and we should all be aware of that and working towards de-stigmatizing all sorts of things to achieve a world without oppression. 

 Gender
    The one male patient in this film is white and also a ballet dancer. For the only eating-disordered male to be a ballet dancer is reinforcing a problematic narrative about males and eating disorders. By the one man being a ballet dancer the film is sort of suggesting that only effeminate men or men engaged in feminine things like ballet are vulnerable to eating disorders. This is just false. Many men with eating disorders are athletes but I literally have never met one that was specifically a dancer. One sport or active discipline isn't more susceptible to eating disorders then the other. This idea only shames men who have eating disorders. It's true that statistically more women are affected, but it's also more men than you might guess. In the United States 10 million men will suffer from a clinically significant eating disorder at some point in their lifetime (source). And we haven't even talked about men of color, who are there is exactly one study one that I could find. 
    Additionally, there are no gender-fluid characters in the film or even mention of gender fluidity. However, 16% of transgender college students are affected by eating disorders (source). 
    There are other things missing from the film too, such as people over the age of 25 having eating disorders, people with different physical abilities having eating disorders, etc. There's just a lot left out unfortunately. My point is eating disorders don't discriminate. And this film sort of makes it seem like there's a specific "type" which is false and dangerous. Let's be very clear about how dangerous eating disorders are: they are the most deadly of the mental illnesses (source). THE MOST DEADLY. You have a better chance of surviving depression, anxiety, schizophrenia, bipolar disorder, etc. This isn't to be taken lightly. Please understand that if you or someone you know is suffering with an eating disorder you don't have to bear that shame alone, and hopefully you'll learn you don't have to bear it all. Films like this are dangerous because they reinforce narratives that create barriers to people getting the help they need. 

    This is getting so long, you guys. But, if I'm going to do this I'm going to do it right. Here's what the film gets right and wrong about eating disorders: 

 RIGHT 
- Some people will need several rounds of treatment before they can live at home or in the community for an extended period of time 
- Eating disorders are not about the food - Having a severe, untreated eating disorder WILL kill you. The film actually holds this pretty okay. Not great, but pretty okay. 
- Some people will leave treatment because they aren't ready for it and return to it when they are. As long as they are medically stable, this is generally okay and can actually be good to get some perspective.
 - According to the white man psychiatrist "looking for one reason" that caused a person's eating disorder "is a losing battle. It's never that simple." I agree with this. 

 WRONG
 - People with eating disorders aren't going to see their body the way you might. In the film, the protagonist Eli has this sort of transcendental moment where she sees how emaciated her body is and it saddens her. She immediately goes to treatment after this experience. This is not real life. People with eating disorders DO NOT see their body they way others do. Trying to get them to see how thin they are is not going to work. Generally when a person with an eating disorder acknowledges that they were unhealthily thin it's after they've been in recovery for a good long while. Not being able to be realistic about your body IS part of an eating disorder, so people can't just see how thick or thin they might be and then want to change.
 - All the race, class, and gender stuff I already mentioned 
-"In-patient" does not look like living in a house with a staff person and other patients. That's residential care. True in-patient care is in a hospital.
 - In my humble opinion, it would never in one million years work to let patients choose the foods they will eat. Of course patients should have options and choices and as much autonomy as they can handle to pick their own meals, but it would not work to let them choose from literally anything and to agree to accommodate any requests. (In the film the rule is you can eat whatever you want as long as you are gaining weight). Those of us that do this work know how absurd this is. People with eating disorder severe enough to need treatment are not able to choose their own foods. Additionally, for their own safety and to ensure that nutritional needs are being met, they plan their meals with a dietitian. There were no dietitians in the film and they are a key player in eating disorder treatment. 

  Alright friends, I think that about covers it. Actually it doesn't, there's one more thing I want to write about but we'll call that part 2. Get out there and use your critical thinking skills as well as your compassion. 

 Much love,
 Veronica