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John Doyle: Netflix’s To the Bone is simply good fiction about anorexia

The Netflix drama To the Bone has taken a hammering since it started streaming last week. In fact, it was taking a beating as soon as a trailer was released some time back.

It's about anorexia nervosa, you see. And it has been attacked for "glamorizing" the disorder, called "irresponsible" and accused of potentially triggering anorexia among young female viewers simply because it depicts it.

Simultaneously, To the Bone has been praised as "honest." A Salon review included this: "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."

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There is no consensus because, as with Netflix's 13 Reasons Why and its depiction of teen suicide, the portrayal of mental illness is considered fraught. Almost any fiction that depicts young people with mental-health problems can be considered as sensationalizing the issues. Parents, teachers and a small army of education professionals tend to look upon these fictions as if they were documentaries and they fret about the fiction prompting copycat reactions from sensitive young viewers.

There is a point where this becomes ridiculous. TV drama cannot instigate severe depression and thoughts of suicide, nor can it cause anorexia. It is obscenely condescending to young audiences to assume that they are too naive to grasp the nuances of drama and that they will copy what they see. Approaching these fictions in a ceaselessly reductive manner is unhelpful.

In the case of To the Bone, the central figure is Ellen (Lily Collins), who is on one final push to overcome her severe anorexia by entering a group recovery home. Keanu Reeves plays the home's head doctor, a guy who has an unusual and harsh approach to making his patients better.

Ellen's stepmother Susan (Carrie Preston) and mom (Lili Taylor) are around to stir up issues of blame and resentment. And then there are Ellen's co-patients in the recovery program. Each is a representative type, but this doesn't mean a gaggle of young white women obsessed with being thin and beautiful – the group includes a young black woman and a male ballet dancer. What the drama amounts to is Ellen descending to the depths of the anxiety that caused her anorexia and, in reaching the bottom, being forced to acknowledge that she actually wants to live, to be healthy and to heal. The drama opens with a statement on-screen which declares that it contains "realistic depictions that might be challenging for some viewers." This is true.

Ellen is a talented artist who dropped out of college after her obsessive drawing about thinness seemed to cause another young woman to go too far in her quest for thinness. She is resentful and angry about everything and, really, the movie is about searching for the core cause of her anorexia. The upshot, in the end, is that the cause has less to do with her than it does people around her.

The movie is the work of Marti Noxon, who spent part of her teenage years in a struggle with anorexia. Now 52 and a writer-producer who has written for Grey's Anatomy, Glee, Mad Men, UnREAL and created Girlfriends' Guide to Divorce, Noxon is one of those women in Hollywood who is enraged by how the popular culture sees women as disposable based on their looks and age. As she sees it, self-loathing is the main issue for women and, in the end, that's what To the Bone is about.

The movie is neither particularly strong nor is it a failure. It has a sense of humour and doesn't portray Ellen and the other patients as lost souls. It is skeptical about parents and scathing about the medical profession. It is also skeptical, at times, about Ellen herself. At one point, the Keanu Reeves character looks at her emaciated frame and says, "You scare people, and you like that."

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To the Bone is simply a good drama, walking a line between realistic depiction and health-risk warning. In an interview with Vogue, Noxon rebutted some of the criticism by stating, simply, "It's not a documentary." And she's right. Everybody needs to be grown-up about that.

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