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Why Netflix’s To the Bone could be triggering

Jokes about how Emma Stone is “fat” are deeply misplaced and can simply move the goalposts for more vulnerable audiences

By Anna Leszkiewicz

To The Bone opens in an art therapy session. A group of thin, gaunt girls are collaging, cutting and sticking pictures of people from magazines, and inspirational quotes in cursive fonts saying things like, “Never give up. Find a way to make it happen.” One girl rages against the media’s depiction of the “sad, fat girl” verses the loved, happy, skinny girl – until she is interrupted. “Ugh, society’s to blame, the world is so unfair, I have to die,” a sarcastic voice whines from the head of the table. “Ellen, do you think there’s a way you can express that without discounting Penny’s feelings?” the therapist asks. Ellen (Lily Collins) smiles ironically and holds up her artwork – cut-out letters reading “SUCK MY SKINNY BALLS”. Rock music kicks in.

The message is clear. Ellen’s not, like, a regular anorexic – she’s a cool anorexic. As the song continues, we see Ellen wheeling her luggage out of the inpatient facility and assume she’s been kicked out. “Bitch,” another patient says. “Told you you’d lose,” Ellen smirks. “You owe me a carton of camels.” And she leaves, wearing a baggy sweater as a dress, a huge scarf, woolly hat and oversized sunglasses – a caustic Olsen twin in the back of a people carrier. She’s sharp, powerful, edgy – and very, very thin.

The trailer for To The Bone, Netflix’s new film about a recovering anorexic inpatient, caused considerable controversy when it was released last month. Viewers, particularly those with experience of eating disorders, felt that its portrayal of anorexia was irresponsible – thanks to its dangerous combination of a light-hearted tone, potentially “thinspirational” imagery, and detailed depiction of calorie-counting and extreme food-avoidance behaviours; as well as for the makers’ decision to have anorexia survivor Lily Collins become severely underweight for the role. Within hours of its release, screenshots and quotes from the trailer had made their way to pro-ana thinspo blogs. I spoke to many people recovering from eating disorders who felt the trailer was triggering in itself.

The makers responded to these criticisms by supplying their own personal experiences as evidence of their good intentions. “Having struggled with anorexia and bulimia well into my twenties,” writer and director Marti Noxon wrote, “I know first-hand the struggle, isolation and shame a person feels when they are in the grips of this illness.” Emphasising that it was important to her to be “truthful in a way that wasn’t exploitive”, she said, “My goal with the film was not to glamourise EDs, but to serve as a conversation starter about an issue that is too often clouded by secrecy and misconceptions. I hope that by casting a little light into the darkness of this disease we can achieve greater understanding and guide people to help if they need it.”

[See also: The Big Bang Theory is a plague on society]

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Lily Collins spoke similarly. “I’ve been very vocal about my experiences so it was important to me,” she said. “It’s quite taboo even today to talk about it even though it’s becoming more prevalent. To do it in a film to make it entertaining but make it very informational is important.”

It’s brave of both Noxon and Collins to be so generous with their personal experiences. The film certainly doesn’t shy away from the “reality” – or, rather, one reality – of anorexia. But this pursuit of “realness” is what makes so much of To The Bone so problematic.

We get several close-up shots of Collins’ underweight, semi-naked body. (Here, the camerawork switches to a more wobbly, handheld style, moving from fuzzy to in-focus, to really give us the feeling that we’re casting our eyes over different parts of Ellen’s frame.) “Do you see, do you see what you look like?” Ellen’s step-mother asks at one point. “Do you think that’s beautiful?” But while many viewers will feel shocked and saddened by the shots, the reality is that for many others, regardless of intention or how many other characters insist Ellen looks “like crap”, these images will be aspirational.

The young, white and already very thin Lily Collins is fetishised by Hollywood, fashion and the media at large. She ticks all the boxes for what society considers beautiful, and remains so at her lowest weights in this film. (The actress even recounts receiving compliments on her body after losing weight for the film – clearly, there is a very, very fine line between general societal glorification of thinness and actual thinspo.) And when Ellen is fully clothed, she looks like the pictures you find on anorexia Tumblrs – all messy bun, extra-long sleeves and over-applied mascara, lit cigarette in hand. Her wardrobe consists of enormous chunky knitwear, hoodies, plaid shirts, baggy overalls, and those big sunglasses. We see her wrapped up in big dark blankets. These visuals may speak to many people who have suffered from eating disorders – not because this is what most eating disorders look like (it’s not – most people with EDs are of average or above average weight) but because this is typical pro-ana imagery. Even the film’s title sounds like the kind of username you see in online thinspo-sharing communities.

“I thought you should know about her tricks,” Ellen’s stepmother says when she drops her off at the centre. “Oh, we know all the tricks,” the nurse replies. It’s true – in its pursuit of “reality” To The Bone becomes a how-to guide for hiding disordered eating from friends and family, even though eating disorder charities like Beat advise that the media avoid specifics of behaviours around food in the depiction of eating disorders, as they can encourage audiences to adopt the same techniques. (I won’t describe them here, but the list of “tips” I noted down whilst watching is long.) While charities also caution against the use of numbers (be it weight, amounts lost or gained, calories) in eating disorder stories, they’re everywhere here – even if adult characters caution against talking about them. Viewers will learn how many calories are in a bread roll, a slab of pork, green beans, plain noodles, a nub of butter, a Goo Goo Cluster – even the drip bags used in nasogastric tube feeding.

Ellen’s anorexia looks like how many people expect anorexia to look. She’s severely underweight. Her family constantly comment on her appearance, aghast at how frail she looks. Strangers offer her food. People warn her that she’ll soon be burning off not fat, but muscle and organ tissue. Still, she is not considered to be at “bottom”. “Bottom” is a concept that comes up a lot in the film – it’s her doctor’s controversial (but, within the film, ultimately correct) opinion that Ellen has to reach rock bottom before she will fully commit to getting well again. Dr Beckham (Keanu Reeves) insists to Ellen’s step-mother, “The problem with treatment, for some of these kids, is that we won’t let them hit bottom. It’s too hard to watch. But for Eli, the bottom’s critical.”

The suggestion is that Ellen’s eating disorder isn’t life-threatening unless she is the thinnest she can possibly be without dying. But the collective cultural script that says anorexia has to look like this to be lethal is misleading. “How media images really affected my own eating disorder,” the writer Carrie Arnold told me, was by “making it much more difficult for others to recognise there was a problem and for me to recover.”

Attempts to portray Ellen as a “real” person with a spiky, witty personality and a sense of humour about her illness also leads to clunky, offensive dialogue, be it repeated references to “calorie Asperger’s” and liberal use of ableist terms, or Ellen insisting she’s “not on-trend enough” for self-harm. Ellen’s love interest bizarrely jokes that women are “basically a bunch of portable holes for men to fuck” in an attempt to suggest he isn’t misogynistic like most men. Jokes about how Emma Stone is “fat” because “she’s at least a size six” seem, again, deeply misplaced – while some viewers will laugh at the ridiculousness of these comments, it can simply move the goalposts for more vulnerable audiences.

Early reviews of To The Bone have been surprisingly positive in terms of its potential impact on viewers. The Las Vegas Review-Journal headlined its review, Netflix’s ‘To the Bone’ Depicts, Doesn’t Glamorize, Eating Disorder, while Grazia went with Why To The Bone Does Not Glamourise Anorexia. Salon insisted that the film is “more than just its trailers”. All focus on how grim Ellen’s life is. Residential home life is “shown in a deeply unglamorous way,” the Grazia review insists. “Aspirational this is not.” Salon agrees: “The film itself is an admirable and empathetic work that does not romanticize anorexia or the young woman being ground into nothingness by the disease.” But films don’t need to portray eating disorders as sexy or fun in order for them to be potentially triggering. The relationship between the media and eating disorders is incredibly complex, and thinspiration can come from unlikely sources. That’s why so many charities create such specific guidelines, guidelines that this film often doesn’t adhere to. America’s National Eating Disorders Association has reached out to Netflix asking the film to link to its helpline – bit it’s still unclear whether the film will include treatment resources.

One subplot of To The Bone involves a Tumblr Ellen used to run, where she would post her drawings. It was popular – so popular that other patients at her centre know who she is before she arrives; so popular that she, at one point, had a stalker. While it was never Ellen’s plan, these drawings were popular because they were used as thinspo by many of her followers – and one of her most dedicated followers eventually killed herself. Her sister, eyes full of tears, gets angry about the blog during a group therapy session. “Now people want to be like her, and look like her, and go through what she’s going through.”

At one point, Ellen starts suddenly discussing this with Dr Beckham.

“I didn’t mean it. I mean, I didn’t mean for my drawings to do what they did.”


“On Tumblr? I know Susan told you what happened and, well, it will come up, I bet.”


“I was just doing what all my teachers told me to do.”

“Draw what you know?”


“I hear you. Just, keep it to yourself. For now. Ok?”


Here, the script knows that telling stories from personal experience, even with good intentions, is not enough to prevent those stories from being dangerous when they reach other people. But as a cultural artefact, To The Bone operates in the same way as Ellen’s artworks. In the eyes of those who made it, the film is truthful, personal and authentic. It’s relatable for those going through the same things, and, thanks to Netflix’s platform, it will doubtlessly be very, very popular. It’s also potentially aspirational and triggering – no matter how good the intentions of the people behind it.

As with 13 Reasons Why and its depiction of teen suicide, it’s difficult to talk about potentially dangerous portrayals of mental illness without sensationalising them. TV can’t cause depression or anorexia or any other mental health issue. And if predominantly young and teenage audiences are effusively relating to a programme about mental health, it feels both patronising and naïve to insist that these shows are unsafe for the people they’re made for. As the mental health writer Bethany Rose Lamont told me, “It’s simply too reductive and encourages a sense of moral panic that does not support those struggling.”

There needs to be less taboo surrounding mental health problems like eating disorders, and some outlets are calling To The Bone “the first big-screen drama to treat anorexia as a serious subject worthy of discussion”. That’s to be applauded. And there are some moments in To The Bone that may well resonate with, and even help, people who are going through experiences like Ellen’s. An excerpt of Anne Sexton’s poem “Courage”, in particular the line, “Your courage was a small coal / that you kept swallowing”, gives Ellen an epiphany that helps her move forward in her recovery. A scene in which Ellen’s mother cradles her and bottle-feeds her like a baby, while she cries, is uncomfortable yet surprisingly tender and moving – and one of the rare moments that feels unlikely to pop Tumblr dashboards any time soon.

But it must be possible to create works that are relatable and honest without resting on the specific imagery that motivates so many illnesses, or disregarding such high numbers of the media guidelines put in place by experts. There must be a way to portray mental health without falling into the same tired traps. This film isn’t it.

“Nobody died because of Ellen’s artwork, ok?” Dr Beckham insists during group therapy. “There’s plenty of stuff out there for people to fetishise.” He’s right, of course – there is. To The Bone is just another thing to add to the list.

For support and information about eating disorders, please visit Beat. You can call their helpline on 0808 8010 677.

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