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Open Collection of Student Writing (OCSW)

The Refusal to Eat and the Decline of Weight

Summary

To the Bone is a film about a 20-year old female named Ellen also known as Eli who depicts Anorexia Nervosa. By the time she is introduced, she has had four inpatients and going on to the next one thanks to her stepmother, Susan, who has fought hard to get her an appointment with a really good doctor named Dr. Beckham. Before admitting Ellen, Dr.

Beckham tells her that she has to agree on certain things. The agreement conditions include that neither her or her parents are allowed to talk about food, she is on her own, and she has to agree to a minimum of six weeks inpatient. Ellen accepted Dr. Beckham’s conditions to go to the treatment program at a threshold house, where they have group therapy, end of day check-ins, and a torture chamber (dining room) where every patient has to sit down at dinner time. At the threshold house there are six other individuals with eating disorders, such as bulimia, binge eating, and anorexia. Throughout the film, Ellen keeps losing weight to the point where she is about a day to getting a feeding tube. She is seen wrapping her fingers around her upper arm constantly to see that she’s not gaining weight. Towards the end of the film, she leaves the threshold house because Dr. Beckham didn’t reassure her, she mentioned that they “all buy the hype, but no one gets any better” (Miller, Curtis, & Lynn, 2017). She left to Arizona with her mother Judy. While she was with her mother, Judy tells Ellen that as a baby she did not hold her or bond with her as much. Not only that, but Judy felt that it would be healing for both of them if she allowed her to feed Ellen. After getting Ellen’s consentment, Judy got a bottle with rice milk, held her, rocked her, and put her to sleep. Following that, Ellen is shown in a dream-like state.

She walks up a hill, towards the moon, and faints. While she is fainted, she sees herself, from the top of a tree, and can’t believe it’s her. Soon she eats a piece of charcoal and comes back to life. Subsequently, she goes back to Susan’s house and accepts to go to the threshold house again.

Diagnosis

DSM-5 Evaluation

Client Name: Ellen

Diagnosis:

Code: F50.01

Name of Disorder: Anorexia Nervosa, Restricting type, Extreme.

Additional Information:

Medical Problem(s): N/A

Psychosocial Problem(s): Code: Z62.820

Name: Parent-Child Relational Problem Code: Z69.011

Name: Personal history (past history) of neglect in childhood Code: Z59.9

Name: Unspecified Housing or Economic Problem

Justification

Ellen (Eli), suffers from Anorexia Nervosa, which is the “restriction of energy intake relative to requirements, leading to a significant low body weight” (American Psychiatric Association, 2013). During the film, she would perform certain tasks that would help her lose more weight because of the fear of gaining weight. For example, Ellen would go on a hike with her sister to burn calories, flushed down her antidepressants because she was afraid that they would make her gain weight, and did a lot of sit ups leaving many bruises on her spine. There is also a scene where she asks a guy named Luke (he lives in the threshold house) how he could eat, which makes her panicky to even ask that question. Not only that, but Ellen gets frustrated when Luke tries to make her eat a candy bar, she tells him to back off in a serious voice. Also, that same guy, Luke, invites her to go to dinner. She accepted to go because he said that if she goes with him, they could walk to the restaurant and she does not have to eat. At the restaurant, she only chews the food, but does not swallow it, she would spit it out on a napkin. She is also seen running up and down the stairs repeatedly and she would not eat most of the time. Not eating got to the point of Ellen fainting at the bus station when leaving to Arizona with Judy.

Someone at the bus station tells her that she needs to eat, but she said that she had just stood up too quickly.

Equally important, Ellen meets the criteria for the restricting type of anorexia nervosa because she does not engage in “recurrent episodes of binge eating or purging behavior,” (American Psychiatric Association, 2013) she loses weight by eating the least amount possible and exercising excessively. “The individual suffering from restrictive anorexia is often perceived as highly self-disciplined. They restrict the quantity of food, calories and often high fat or high sugar foods. They consume far fewer calories than are needed to maintain a healthy weight” (Ekern, 2018).

Although it does not mention her weight or BMI during the film, the severity of her disorder is extreme (BMI < 15 kg/m^2) due to the fact that she is close to getting the feeding tube, which she has had before. She needs to be weighed very often to see if she is improving, but her condition keeps getting worse. Each time she would get weighed, she would make up an excuse to why she has lost weight. For example, there was a scene when she was getting weighed by Susan and she said that she had gotten the cold.

In spite of the fact that she has anorexia, it does not mention any medical problems nor any medication that she is currently taking. It only indicated that she would flush her antidepressants, but she is never seen taking any. Even though it does not say much of any medical problems, she has had to go through other problems throughout her life including: parent-child relational problems, neglect in childhood, and an unspecified housing and economic problem. Having her parents divorced, has been a hard situation for Ellen. She lived with her mother 18 months before, but her mother could not take it anymore, she did not like to see her daughter die in front of her eyes, so she put her bags out for Ellen to leave with her father. In the film, Judy lets Ellen know that she did not know about postpartum depression and she feels like it was that which caused her to neglect her during her childhood. As a baby, Judy did not hold or bond with Ellen as much because as I mentioned, she felt like she had postpartum depression.

Also, her father Jack is not shown during the entire film because he is always working. He did not even have time to go to a family therapy that Dr. Beckham organized to get a sense of her family. During this family therapy, Susan let them know that Jack could not make it since he is working to pay all the medical expenses of Ellen, which gives a sense that they have some sort of unspecified economic problem due to Ellen’s condition. In addition, Ellen has an unstable housing problem because as I said earlier, her mother put her bags out on the street for her to leave with her father. At her father’s house, she could stay as long as she allowed them to weigh her. That being said, Ellen has had an unstable housing problem due to the fact that her parents are divorced.

Critique

To the Bone, does a good job in showing what anorexia nervosa is. In part that is because it was “created by and with individuals who have struggled with eating disorders” (Miller, Curtis, & Lynn, 2017). These people know what it is like to live with an eating disorder, which helps make it a reliable movie since it is not being made up. However, it did not show a few of the signs and symptoms of anorexia, such as: “engaging in ritualistic eating patterns, continued fixation with food, recipes, or cooking; the individual may cook intricate meals for others, but refrain from partaking” (Ekern, 2018), or self-induced vomiting to get rid of any food that she has eaten. During the film, she does not engage in ritualistic patterns such as hiding food or eating when she is alone. Also, when she does eat, she never tries to get rid of the food by

self-induced vomiting, she just exercises excessively. Whenever she’s going to eat, she is sitting at the dining table, but she never hides it, she just leaves it on the plate if she’s not going to eat something. Although it doesn’t show those signs and symptoms, it does show most of them.

Some of them include restrictive eating, losing significant weight, exercising excessively, obsession with calories, not getting on her menstrual period, spitting out food after chewing it, and obtaining lanugo (body produces more hair to keep the body warm). In regards to the signs and symptoms, everyone experiences different ones.

Additionally, the treatments that are shown in this film are family-therapy, in-patients, medical prescription, and other unknown treatments that Ellen has had to go through before the movie starts. Two other treatments for anorexia that were not shown in this movie are nutritional therapy and Cognitive Behavioral Therapy. Nutritional therapy is often given by a dietitian who helps individuals with anorexia make a plan to achieving a healthy eating pattern or habit.

Whereas, Cognitive Behavioral Therapy, “focuses on behaviors, thoughts and feelings related to your eating disorder. After helping you gain healthy eating behaviors, it helps you learn to recognize and change distorted thoughts that lead to eating disorder behaviors” (Mayo Clinic Staff, 2017).

Besides that, To the Bone includes a stereotype perpetuating stigma, which is that they do not get better. It rarely shows individuals making progress even though they are getting treated for their disorder. Ellen even recognized that at the threshold house no one is getting any better, which is true because either they stay the same or their condition worsens. For the most part, it shows a lot of what people with anorexia nervosa go through and their everyday struggle of not wanting to gain extra weight.

References

American Psychiatric Association. (2013). Desk Reference to the Diagnostic Criteria from DSM-5. Arlington: American Psychiatric Publ.

Ekern, J. (2018) Anorexia Nervosa: Causes, Symptoms, Signs, & Treatment Help. Eating Disorder Hope. Retrieved from https://www.eatingdisorderhope.com/information/anorexia

Mayo Clinic Staff. (2017). Eating disorder treatment: Know your options. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/eating-disorders/in-depth/eating-disorder-treatment/art-20046234

Miller, K., Curtis, B., & Lynn, J. (Producers), & Noxon, M. (Director). (2017). To the Bone [Motion picture]. (Available on Netflix).

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