Why We All Need To Read Carolyn Costin’s Review of To The Bone

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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 ancenter. 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+VietsCarolyn 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.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.

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