To the Bone, Netflix’s highly anticipated and controversial film about a young woman with anorexia, began streaming this morning. Buzz has been building for months about the movie, starring Lily Collins, and it’s received both praise and criticism (based on advanced screenings and the trailer, released last month) for its portrayal of such a sensitive topic.
For people with real-life experience with eating disorders, reaction to the movie has also been mixed. A writer for In Style who recently completed a treatment program herself applauded the movie for touching on some of the most important (and frustrating) things about recovery that often don’t get any screen time. Meanwhile, an article in The Guardian, also written by someone with a history of disordered eating, calls To the Bone “shallow, sexist, and sick.”
The movie revolves around 20-year-old Ellen and her experience in an in-patient recovery program. To find out what someone who treats patients for eating disorders thinks of the film—and suggestions that it glamorizes anorexia, or could be triggering for vulnerable viewers—Health spoke with Bonnie Brennan, a licensed professional counselor and senior clinical director of adult services at Eating Recovery Center in Denver. Here’s what she thinks the movie got right and wrong, and what people should know before watching.
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The film does a lot of things well
Brennan, who has worked with disordered eating patients in outpatient, residential, and inpatient settings, says To the Bone is a “really touching, powerful, and honest attempt to portray eating disorders.” And while she does take issue with a few things in the film, she says that overall, “I thought the artists did a great job, and I applaud them for their efforts.”
She was pleased to see diversity in the cast; along with Ellen and a few other young white women, the residents of the treatment center include a 20-something male, an African-American woman, and a pregnant woman. “Of course, more diversity could still be represented, because eating disorders come in all shapes and sizes and across all ages,” says Brennan. “But I’m glad they didn’t just stick with the version of a typical anorexic most people are used to.”
The movie also does a good job portraying a lot of the behaviors that people with eating disorders partake in, says Brennan, including ones that people unfamiliar with the topic may know nothing about. Ellen, for example, is obsessed with counting calories and measuring her arm circumference, and she does sit-ups so frequently that her back is chronically bruised.
“They highlight how the exercise Ellen is compelled to do is not enjoyable,” says Brennan. “You can see the real difference between someone who exercises for health and well-being and someone who’s doing it for painful, obsessive reasons.”
Yes, it can be triggering
“There’s no doubt that, for folks who have been affected by eating disorders, they’re going to see some stuff that’s hard to watch,” says Brennan. That’s true of the characters’ physical appearances, as well as their behaviors around food. “One thing to know about eating disorders is that there’s this competitive side of wanting to be the sickest and the thinnest,” she adds, “and those things probably will bring up, for some folks, the lure of the illness.”
That doesn’t mean the movie will cause people to relapse, however, and it doesn’t mean that anyone who’s struggling automatically shouldn’t watch it.
“I recommend that if you are affected by eating disorders in any way, that you watch this with a support person you can trust,” says Brennan. It can also help for people to make a note of specific things in the movie that bother them, she says, and have a conversation afterward with a counselor or someone they can trust.
The film’s casting of Collins—who struggled with anorexia and bulimia in her teens—has also been heavily criticized by some. Brennan acknowledges that the actress’s decision to participate in the film “must have been incredibly hard and painful, and I’m going to assume it came from a place of love and purpose.” Collins and the film’s director have also spoken out about that decision, and the steps they took to make sure she lost (and regained) weight for the role in a healthy manner.
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It highlights the role of families
When To the Bone isn’t focused on Ellen’s life in the treatment center, it’s exploring her relationship with her family—including a stepmother who doesn’t understand her, an absentee father, and a sister who admits she’s angry that Ellen won’t “just eat” and get better.
“Often families don’t know what to do when a loved one is suffering; they feel like they’re doing everything wrong,” says Brennan. While Ellen’s stepmom says and does a lot of questionable things, “she was willing to step up and be there for the hard stuff, like getting her into treatment,” Brennan says.
Brennan does think that the fact that Ellen’s dad was too busy working to attend family therapy or make it home for dinner was one stereotype the movie didn’t need. (He never once appears on screen.) “As a clinician who’s worked with families for many years, I will say that our dads really are showing up to support their sons and daughters in treatment.”
The film’s version of therapy is very unconventional
People should not watch this film expecting to learn what typical treatment for an eating disorder is like. The program is referred to as inpatient, but when Ellen shows up she is surprised to find a large residential house. “Inpatient facilities are usually more like hospitals,” says Brennan. Some of the program’s “rules” will likely raise eyebrows, as well. “The way the meals are done, with the residents sitting around the table without any staff, getting to decide what they want to eat or not eat—that is very atypical of eating-disorder care,” says Brennan. And while some of Ellen’s housemates have been at the facility for quite some time—six months, in one case—that’s generally not the case for people in inpatient care. “That’s pretty luxurious, and most folks don’t have the resources or the benefits from third-party providers to support that long of a stay,” says Brennan.
Still, Brennan says, the message that the program’s doctor (played by Keanu Reeves) tries to get across rings true. “He has a statement in there that is very aligned with our center’s mission: He asks the character how she wants to live her life moving forward,” she says. “We believe that a key to recovery is finding a meaningful life that’s worth being in your body and eating food and making the right choices 365 days a year.”
It’s not perfect, but it’s a good start
For people with an advanced understanding of eating disorders—their own or a loved one’s—To the Bone will probably feel oversimplified and stereotypical, says Brennan. “But for families or people who just want to understand this issue a little better, I think we need to start simple and build from there,” she says. “In an hour and 40 minutes, I think they cover a lot of territory.”
Brennan says it’s important that the film makes the point that treatment isn’t easy. “It does a good job showing that this is a painful process and that it’s hard to face this thing and manage all these thoughts and emotions.”
Overall, Brennan says that any film that shines a light on what living with an eating disorder is really like—the pain, the frustration, the unusual behaviors, and yes, even the dark humor—has the potential to do a lot of good. “We like to say that eating disorders thrive in secrecy and isolation,” she says, “and this film does a great job of exposing some of that stuff.”
This article originally appeared on Health.com