To Watch or Not to Watch: That is the Question

Navigating “To the Bone” and other Potentially Triggering or Inflammatory Movies about Eating Disorders

Like most things in life there are benefits and risks that come with exposure to media, especially media that depicts sensitive or potentially life-altering subject matter such as eating disorders, suicide or mental health. As you may have already noticed from the controversial conversations about it, the Netflix movie, To the Bone is no different. The film depicts a young woman, Ellen, in the throes of her eating disorder and follows her through the recovery process which the synopsis points out, includes
help from a “non-traditional doctor” played by Keanu Reeves. It may come as no surprise that the main character, Ellen, is a young, white, very thin, upper middle-class woman, and that the particular eating disorder she is dealing with is anorexia nervosa. Hollywood tends to over-rely on this stereotyped depiction of eating disorders, despite the fact that in reality, eating disorders and the people they impact are much more diverse.

As one of the nation’s longest-running providers of evidence-based treatment for children, adolescents and adults with eating disorders we’ve been asked by numerous patients and families in the previous weeks how to handle such a film.  And while To The Bone may be a new film, this is far from a new question.  Over the last several decades, similar questions have been raised in response to documentaries, blogs, fictional books and memoirs written by individuals recovering from eating disorders.

Decades of observing the impact of this type of media has reinforced our recommendation that individuals who are currently struggling with an eating disorder or those who are in the early stages of treatment and recovery don’t typically benefit from watching movies or reading books that display any of the following characteristics:

  • extremely graphic depictions of people engaged in eating disorder symptoms such as bingeing, purging, chewing/spitting, body checking, over-exercising, self-harming or abusing drugs and alcohol
  • detailed descriptions of ED thoughts and behaviors that are left unchallenged, unexplained or are not paired with sufficient education regarding the consequences
  • conversations that include specific numbers such as weights, clothing sizes, calorie counts or repetitions of exercise.

If you notice any of these characteristics in a movie, show or book, it should be a red flag that it might not be a beneficial resource or recovery-focused activity for someone who is currently struggling.

We always look to support popular media that finds a way to raise awareness and stimulate meaningful discussions about eating disorders in safe and non-triggering ways. With that in mind, we went into our own viewing of this newest movie with high hopes and an open mind. Unfortunately, what we found was that To The Bone ultimately ticks off all three of the red flags mentioned above. Furthermore, the film’s depiction of treatment methods and treatment protocols are far from helpful, safe, or accurate.  As a team of specialized professionals, many of whom have spent their entire careers learning about, researching and utilizing evidence-based treatments for eating disorders, this film was, quite frankly, disappointing and at times difficult for our staff to watch.

On the flip side, it did do a good job of illustrating the immense pain and struggle faced by those who are impacted by these illnesses. It also got people talking about an issue that is usually hushed in society despite the fact that eating disorders impact 20-30 million people.  Our hope would be that some viewers of the film gain insight or information that could help them check in with a friend or loved one who is showing warning signs and needs help.

Taking into account both perspectives and the possibility for all the positive and negative impacts, it’s crucial to think  critically about the media introduced to us as communities, families and individuals.

If you are a therapist, a parent, educator or friend of someone with an eating disorder

It’s really important to empower anyone considering watching a film about eating disorders to feel like they can disengage safely and with your support.  Let them know it’s okay to decide not to watch because it has the potential to be harmful for them and their recovery.  This can be a hard but powerful decision because it builds confidence and sets a precedent for recovery-focused decision-making.  How? Today, it might be saying no to a Netflix film that “everyone else is watching and talking about” but tomorrow it could be saying no to a dangerous cleanse that a favorite celebrity is promoting on social media or saying no to a friend that encourages you to step on her bathroom scale. Learning how to say no to such things, even when the societal pressure and internal urges are strong, is imperative for long-term recovery.

If you have an eating disorder or are in recovery from an eating disorder…

If you’re like a lot of our patients, seeing a trigger warning at the start of a film or hearing in advance that it might be detrimental isn’t always a deterrent and might even make the content more intriguing. We’ve heard from some of our patients that they choose to watch the film despite their own reservations and knowledge of the content.  Most of the reactions included versions of the following:

  • I found myself comparing my body to the actress in the film and thinking that maybe I wasn’t deserving of or didn’t really need treatment since I wasn’t as thin as her.
  • I found myself wishing I could go back to my eating disorder.
  • I was tempted to use “a little bit of my ED behaviors” and was reassuring myself I wouldn’t let it get that bad.
  • If she [the actress Lily Collins] can “lose weight safely” for this role after recovering from an eating disorder in real life than maybe I can too.  

Despite what may be positive intentions for this film, it’s important to be realistic about how it actually plays out for the millions of people with eating disorders who watch it. While not everyone will have reactions like these, we think it’s important for individuals and support people to know it’s a possibility that the person who is struggling with an eating disorder may overlook the negative aspects of the eating disorder on screen and only see the perceived positive or glamorized aspects.

If you are struggling with whether or not to watch this film, or engage with any other eating-disorder focused media, remember that it’s okay to say no. At the very least, we encourage you to discuss your decision with a treatment provider or trusted support person.  If you decide together that watching this type of film might actually be beneficial at certain stages of recovery, check out these guidelines for watching safely.

Some of the most important ways to enhance recovery and prevent relapse include: continuing regular contact with treatment providers, following evidence-based recommendations, engaging in regular self-care and creating a home environment that is conducive to your continued healing and recovery. In this case, that might also include creating a Netflix watchlist that doesn’t have anything to do with eating disorders.

Do you have thoughts on the film or the media surrounding it? Join the discussion on our Facebook page.


Written by Kate Clemmer, LCSW-C, Community Outreach Coordinator, The Center for Eating Disorders at Sheppard Pratt

From Collegiate Athlete to Pregnant Mom, ERIN MANDRAS talks summer body image pressures {Guest Post}

 


mandrassoccer2 Erin Mandras Erin Chooses body positivity

 

 

 


I went to pick a magazine off the rack the other day at the store, and, just like most people, I am automatically drawn to the headlines highlighted in big, bold capital letters on the front covers.

“Flat Abs, Lean Legs, Firm Butt.”
“Drop XX lbs. Fast.”
“Flat Belly Now!”
“Drop A Jeans Size In XX Days.”
“Sexy Abs Fast.”

You get the point. It is only natural for me, or anyone, to assume that these characteristics are being promoted because they depict beauty, and that sexy is defined as thin, lean, flat, and firm. As we are right in the thick of summer season, and attaining a “bikini body” is at the forefront of peoples’ minds, I picked up one of the magazines and skimmed through it. Thankfully, those magazine headlines don’t effect me in the same way they once did.

I suffered from an eating disorder at the age of twenty. My desire to appear attractive, and be physically fit fully dominated my ability to focus on being healthy. My initial attempt at losing “a few pounds” turned into an obsession with food restriction and excessive exercise. And, it all began in the summertime when I knew I would be in a swimsuit with my friends, and my body was more exposed than in the winter season. Little did I know that my drive to be thin and sexy would lead me down a deep, dark path of depression and anxiety.

I am an athlete. I have always been active and competitive in sports, particularly soccer. Short in height, I needed to have strength in my upper and lower body to be successful. At the time of my eating disorder, however, I lacked size, power, and personality–all attributes that had contributed to my successes on the field. I quickly realized these qualities I once possessed had dissipated and what I thought was making me better, sexier and more confident was actually making me weaker and more insecure.

Fast forward thirteen years.

I am now 23-weeks pregnant with my third child, and summer has begun once again. My body is larger than it has ever been in my whole life.  But so is my heart. I have two little Erin Mandras hits the beach with her kidsboys, who love to go swimming at our neighborhood pool. It is in this environment that I am forced to make a decision: embrace my features and my body, and enjoy myself and my children; or turn back to my eating disorder and disengage from life and from my family.

Love, family, and happiness now far outweigh a desire to be a certain body type. And, for me, who is not happy, joyful, or lively when I am dieting or focusing on dissatisfaction with my body, I choose to live life.

Life is too short to focus solely on my appearance or socially constructed beauty ideals. I much prefer to enjoy myself, exercise healthily, and concentrate on being the best person, mom, wife, daughter, and friend I can be. That is far sexier than any number on the scale or what I look like in a bikini.

 

Erin Mandras is a blogger and inspirational speaker at Kick The Scale.  She’s also a youth soccer coach in the Baltimore, MD area, and cares for her two young kids (Levi, 4 1/2 and Austin, 2 1/2). Prior to these roles, Erin was a college soccer coach at Michigan State University, Towson University, and Loyola University Maryland, and a former women’s soccer player at Michigan State University. She was born and raised in West Bloomfield, MI, is now married to her wonderful husband, Jon Mandras, and resides in Baltimore.   


Wondering how can you start to build a body positive summer for yourself and the people you care about?

Put the magazines down.  Better yet, don’t even pick them up. Create your own headlines.

Local Woman chooses body positivity!What do you want your summer headline to be?

Share with us on Twitter using the hashtag #bodypositivesummer and find out more about the campaign here.

 

 

 

 

 

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

Save

A Reason to Smile ~ A Featured #NEDAwareness Q&A with Benjamin O’Keefe

Ben-headshot-2nd

 

BENJAMIN O’KEEFE is an actor, activist, and writer.  Besides working as a performer, Ben has been an emerging leader in activism work focused on LGBT rights, Youth Rights, and Body Image. In this role, Ben has been responsible for creating many major movements of change – most notably, an International movement against size discrimination by Abercrombie & Fitch. Benjamin will speak about his recovery from an eating disorder at a free event on February 22 in Baltimore where he will also co-facilitate a workshop looking at how individual and collective cultural experiences shape the treatment and recovery process.


Today on the blog, Ben shared with us his answers to some of our questions about the recovery journey so that we could share them with you.  Please feel free to leave a comment here on the blog or head over to our Facebook page to thank Ben for his inspiring responses.

*     *     *

Q & A with Benajamin O’Keefe

 Q: What is one fact about eating disorders that you think is most important for people to know and understand?

Ben: I think the most important thing to know about eating disorders is that they affect no two people the same. They don’t discriminate–even though many people’s opinions on them do. I think that the way we discuss eating disorders needs to fundamentally change. We need to break down the taboo around eating disorders, and start talking about the ways that these disorders affect people from all walks of life and of all cultural make up.

Q: What is one thing you learned about yourself during your experience with an eating disorder and/or the recovery process?

Ben: I learned that I could make it through it anything. Back when I was sick, I never thought that I would make it out of the dark hole that was my disorder. And I certainly never thought that I would make it out to become a person who loves himself so thoroughly–and helps encourage others to do the same.

I learned that, not only am I good enough, but I am great just the way I am.

I learned to surround myself with love, whether that be in the people I spend time with or the environments in which I put myself.

I learned to love my reflection, but more importantly to love what that mirror can’t show me. I am more than a number on a scale, I am a person that deserves love and happiness.

Q: Did you face any specific challenge during the recovery process and what helped you overcome it?

Ben: The road to recovery is so different for every person, but one thing that I think everyone can relate to is the isolation that comes with an eating disorder. It’s so easy to feel like we are alone, in fact it’s Ben-headshot-1024x683exactly what the eating disorder wants you to feel, but it’s just simply not the case. There are people that love you, people you don’t even know.

For me, finding a community of people; whether it be people currently struggling, recovered, or just allies, helped me to see that I truly wasn’t alone in my fight, and that we could get through it together.

Q: What are some day-to-day differences between life with an eating disorder and living life in recovery/recovered from an eating disorder?

Ben: I think the biggest difference is my relationship with food. It’s no longer an enemy. I eat when I’m hungry, I stop when I’m full. If I feel like having a cookie, then I eat a cookie. It’s seems simple, but for someone who is struggling with an eating disorder, it’s not.

For me, I now know that food gives life, and that I shouldn’t fear it, but enjoy it. I make healthy choices, and exercise regularly, but it’s no longer about a number on scale, but instead about being the healthiest person that I can be.

Q: What feedback would you give to the support people – friends and family – of individuals struggling with eating disorders? How can they best help to aid in the recovery process?

Ben: First of all I say THANK YOU. This is a journey for you too, and sometimes we don’t think to say thank you to the people supporting us.

Second, I think that my feedback would be to find patience. It’s easy for support people to become frustrated when they see their loved ones taking actions that don’t make sense to them, but it’s important to remember that this is a mental disorder. It’s not a choice.

With patience, love, and support your loved one can make it through. They need you—and your strength and love.

Q: Everyone defines recovery differently. What does recovery mean to you?

Ben: Recovery to me means regaining my reason to smile. When I struggled with anorexia I felt like I was never happy. No matter what I did, how thin I got, what compliment I received on my appearance, it was never enough.

Now, it’s hard to find me without a smile on my face. I love life, and I do my best to take whatever comes my way—good or bad—with a smile on my face. To me that is the biggest indication of my recovery.

 Benjamin Okeefe SMILEYou can find Ben smiling over on Twitter @benjaminokeefe.

 Leave your comments below and head over to RSVP for Ben’s upcoming talk at Recovery in Real Life.  You can also view a video invitation from Benjamin here.

Family-Based Treatment for Adolescents with Anorexia Nervosa: 3 Important Considerations

 

Family-Based Treatment (FBT) is an important evidence-based treatment for anorexia nervosa in adolescents. Originally conceived at the Maudsley Hospital in London, and often referred to as the Maudsley Model, it was further developed by James Lock, MD, PhD and Daniel le Grange, PhD in the United States. FBT is an intensive outpatient treatment involving the entire family whereby parents play a primary and critical role in all of the following tasks:

  • managing the restoration of the child’s weight to a healthy place and supporting the blockade of eating disordered behaviors
  • helping the child to re-establish age-appropriate control and management over their own eating
  • re-focusing the family on healthy adolescent development and relationships separate from the eating disorder

FBT is a highly focused treatment that is presented in three stages. It emphasizes behavioral change and supports a gradual increase in autonomy for the adolescent.  As a psychologist who supports and guides families through this treatment, I thought that it might be helpful for those who are considering FBT to have a primer for the treatment. In thinking about what may be helpful to be aware of when considering FBT, I reflected on the first session I have with each family and thought about all of the crucial messages I try to convey during that time. Below, I’ve decided to share the three messages that, in my perspective, stand as the most important tenets of understanding and implementing FBT.

  1. For adolescents struggling with anorexia nervosa, family support can be the most effective tool for making change. At its core, FBT recognizes that parents are capable of helping their child recover and the therapist’s role is to support them in this goal. When a child is confronted with any serious crisis or illness, investment and nurturing from the family is considered a critical asset and anorexia nervosa is no exception to this. Despite lingering misconceptions about a parental role in the development of eating disorders, FBT is built on the knowledge that parents do not cause eating disorders and that they are, in fact, integral to the recovery process. It is our job as therapists to recognize the strengths and qualities of each family and consider how FBT can be applied within each unique family system. Simply put, the aim of FBT is to empower parents to help their child overcome the eating disorder.  In other words, the therapist serves as a consultant who joins with families as they apply skills they already possess. 
  2. Eating disorders have genetic and biological underpinnings.  As such, adolescents with anorexia nervosa have little control over their illness. Furthermore, periods of malnutrition and starvation can trigger a self-perpetuating cycle of anorexic symptoms that can cause considerable disruption and suffering for the whole family. But to be clear, it is the eating disorder, not the child, which has caused such an interruption in life.  Anorexia nervosa is a devastating illness, the biological, physiological and psychological consequences of which can cause individuals to think and behave in self-destructive ways. It is important that the family works together as a team to help fight the illness and to keep it from embedding further in their child’s life. FBT therapists assist parents in distinguishing between their child and their child’s illness. This distinction helps the family to avoid blaming the child for disruption and stress that is actually a result of the illness, and also makes it easier for parents to take action when they realize they can nurture their child while simultaneously battling against the illness. As a result, energy can be better spent fighting the anorexia, not fighting with their child who is likely already suffering a great deal.
  3. Because of #1 and #2, FBT requires serious hard work and commitment. I am very upfront with families involved in FBT that they will be their child’s primary support AND that eating disorders are insidious and overwhelming illnesses. FBT is not easy. Fighting a devastating illness that has convinced your loved one they are not sick and that they don’t need help, is going to be a lot of hard work. And while it can be grueling, it is also worth it. When we hosted author Harriet Brown as a guest speaker in 2010, we asked her to share her family’s experience in doing FBT with her daughter, and she spoke to this difficulty and to the benefits of this tenet:When we took on FBT, we took on both the responsibility and the power to intervene. That was a tremendously liberating step. The worst part of my daughter’s illness for me was standing by helplessly, watching her suffer and starve. The notion that my husband and I could help her required a huge mental paradigm shift—but once we made it, we were much more effective.” 

In the beginning, FBT will require a lot of energy- energy to monitor your child’s behaviors, energy to learn different behavioral responses, energy to deal with the emotional and interpersonal changes that may come about through this work. I warn my families about the commitment that it takes and I’m honest about the dedication needed. But I also talk to families about the benefits of short-term work to outweigh the devastating long-term effects of an eating disorder and I share with them the facts.  I talk to them about the serious and significant risks of anorexia- physically, emotionally, cognitively- and I have found that families most often agree that avoiding these risks is worth putting in the work. I tell them that FBT has been shown in research (and in my office) to be the most efficacious treatment for adolescents with anorexia that we know about today.

After committing to and sticking with the treatment, I see families eventually begin to talk about “having [their] child back.” I hear families talk about their child’s increased energy, sense of humor returning, interest in friendships again, and reestablishment in the family. I hear the satisfaction when parents talk about receiving feedback from others who approach them just to say that they have recognized a positive change in their child. Over time, I hear families talk about feeling confident that they helped their child recover. They share that they can once again trust their child to make healthy food choices, and they feel a sense of relief that they no longer have to live with the constant presence of the illness. I hear families tell me that the “fight” with the eating disorder gets easier and less demanding, and eventually they don’t need to engage in the battle at all. 

If you think your family member, or someone you know may benefit from family-based treatment, I would recommend starting by talking to a professional about this option, either your current treatment provider or, if you are not currently in treatment, finding a family therapist who is trained specifically in FBT. The Center for Eating Disorders has several FBT therapists in our outpatient department, and we are happy to answer any questions you may have about this treatment modality. You can email us at EatingDisorderInfo@sheppardpratt.org or call (410) 938-5252. Additionally, we encourage all of the families we work with to utilize the book, Help Your Teenager Beat an Eating Disorder (Lock & Le Grange, 2005) as an educational and supportive resource throughout the FBT process. You can also access an extensive selection of journal articles regarding clinical research on FBT courtesy of Maudsley Parents organization.

*     *     *

 Written by Laura Sproch, PhD
Individual and Family Therapist
The Center for Eating Disorders at Sheppard Pratt

 You may also be interested in:

 

 

Decoding the Road to Eating Disorder Recovery

 

Everyone’s recovery journey looks different.  Recovery may take some individuals longer or shorter and involve various combinations of treatment providers, treatment modalities and sources of motivation.  Different people may rely more or less on specific support people and utilize different and diverse coping skills.  Aside from just being different, no one’s recovery will be perfect.  That’s a good thing.  The ups and downs are necessary opportunities for growth and learning during the healing process.  In the midst of that, it can be hard to imagine recovery until you see that others have been where you are and have come out stronger and more fulfilled on the other side.

Over the years many individuals have come here to speak about how, why and with what tools they’ve established their recovery from various eating disorders.  In 2010 speaker Jenni Schaefer shared what recovery means to her and why she kept pushing through what she calls the  “mediocre stages of recovery” to reach a state of being “Recovered.”. In 2011 recovery advocate Johanna Kandel also visited to provide insight on her past fears about recovery like what if I can’t recover?” and “what if I hate being recovered?”  She also addressed the challenge of envisioning yourself without the eating disorder and why it’s never too late to find hope and begin the recovery process.

Most recently  we hosted author, scientist and recovery advocate, Carrie Arnold for a talk entitled Hope Through Science.  Carrie’s presentation was an honest depiction of her own challenges and triumphs in recovery.  She also shared about her  exploration of eating disorders through the lens of a scientist, joking with the crowd that she may be the only one to “read PubMed [journal articles] like its sort of a contact sport.”  During her talk, Carrie provided a glimpse at some of this science and talked about how it impacted her understanding of the illness while also working to propel her forward in recovery.

 

 

Hope Through Science attendees responded to Carrie’s down-to-earth, science-minded and very realistic view of her own healing process.  Her discussion about the science and biology behind eating disorders also goes a long way in helping to break through much of the stigma that surrounds eating disorders so that people begin to understand that they are not to blame for their suffering, but they can be responsible for, and capable of, taking the steps to recover.  Lessening this stigma and misunderstanding about what causes eating disorders is also helpful for friends and family who may be struggling to support a loved one in the recovery process. 


“Loved her personal story and clarification of what an eating disorder is; definitely provided more of an idea for my family.”    ~ Event Attendee

 

“It was interesting to hear information about how science can affect the development and progression of an eating disorder and how knowing the ‘science behind an eating disorder’ could potentially help to unlock a successful recovery process.”    ~ Event attendee

 

As noted above, everyone has different strengths to share and different lessons they learn throughout recovery.  Carrie’s distinctive position as both a recovered individual and a science writer, allows her to add a unique perspective to the host of hopeful stories out there.  If your journey to recovery is similar to Carrie’s, and the insight into the biology of eating disorders informs and empowers you personally, we highly reccommend picking up a copy of her most recent book: Decoding Anorexia: How Breakthroughs in Science Offer Hope for Eating Disorders.  Carrie Arnold can also be found blogging about eating disorders, science and recovery over at Ed Bites.  

Regardless of which path you take to get there, recovery can often feel like an uphill battle, and its not uncommon for individuals to feel hopeless at various points along the way.  That being said, it becomes very important for individuals and their families to be exposed to the many different stories of healing and recovery that do exist.  In order to believe that recovery is possible, sometimes you have to see it and hear it.  This is one of many reasons why we at the Center for Eating Disorders find it important to offer recovery-focused events for the community and our patients.  These events provide a platform for recovered individuals to share their stories and their strength while also reminding us all that the process of recovery looks different for everyone.

*     *     *

If you or a loved one are struggling with an eating disorder or have questions about treatment, please visit www.eatingdisorder.org or call us at (410) 938-5252.  You can also follow CED on Facebook.