As a rule, we love watching actors push themselves to dangerous extremes for their craft. Dramatic physical ordeals become the stuff of Hollywood lore: Leonardo DiCaprio sleeping inside an animal carcass to prepare for The Revenant, Robert DeNiro gaining 60 pounds for Raging Bull, Daniel Day Lewis damaging two ribs after spending the entire shoot of My Left Foot in a wheelchair. (Female bodily transformations — like any time an actress appears to undergo plastic surgery — tend to be more fraught.) Yet To the Bone, Netflix's recent film about a young woman, played by Lily Collins, battling life-threatening anorexia, has sparked a different kind of public conversation about performers and commitment. This time, the question is where Method acting and and psychological self-harm intersect, and at what point one actor's discipline becomes a public-health issue.
In the film, directed by Marti Noxon, Collins plays Ellen, a severely anorexic teenager who is sent for treatment at an inpatient clinic run by an unorthodox therapist (Keanu Reeves). Both Noxon and Collins grappled with serious eating disorders when they were younger — the film is loosely based on Noxon's own experiences — and for both, the film was born of a very personal desire to elevate the artistic treatment of an issue typically been relegated to Lifetime movies or after-school specials. Collins was offered the role just as she was opening up about her eating disorder for the first time in her 2017 self-help book slash memoir, Unfiltered. As she told The Independent, "It was like the world in a kismet situation saying 'this is something that maybe you need to expand upon, something you can maybe bring to more people — start a larger conversation.'"
Like 13 Reasons Why, Netflix's last take on a serious mental-health Issue, the film has quickly become mired in controversy over its shortcomings as an educational tool. And many of the criticisms — in addition to critiques of its focus on suffering over recovery, and of its focus on a thin, white, conventionally beautiful protagonist — have centered on Collins' decision to lose weight for the role under the supervision of a nutritionist. In the view of eating-disorder specialist Jennifer Rollin, who wrote a critical op-ed about the film for HuffPost, the notion that someone recovering from an eating disorder can safely lose weight is "one the most concerning" things about the film.
"Lily Collins saying she lost weight in a 'healthy way' with the help of a nutritionist for the role is like someone with alcoholism saying they drank responsibly for a role," Rollin told me.
Noxon has said that she did not ask Collins to lose weight, and that it was a choice she took on with careful consideration. "Both Lily and I in deciding to make the movie had to evaluate, well, where are we in our recovery? Are we in a good place to make this? And we both felt really strongly that it was something we wanted to do and that would be good for us," Noxon told the Los Angeles Times. In her memoir, Collins calls making the film "the best form of creative rehab," saying that it helped her to face aspects of her disorder that she had failed to fully reckon with, and that she fully recovered from the weight loss she endured for the film.
But for some of the experts I spoke to, Collins' decision was more than an arguably reckless personal choice; it poses a genuine threat for the sort of vulnerable viewers who have already begun sharing photos of her character on "thinspiration" web pages. "We know for somebody with the underlying genetics for anorexia that weight loss, regardless of intention, can trigger their brain to start to get activated. It has put her recovery at risk and it's sent a really dangerous message to other people in recovery," Rollin said.
"If people think, Oh, well, Lily Collins did and it didn't harm her, maybe I can, it becomes a salient example in peoples' minds," adds eating-disorder specialist Lauren Muhlheim. "Hollywood celebrities carry a lot of weight because people will remember that versus a clinician who 10 years in the past told them 'you're at risk if you diet in the future.'" (Muhlheim advises anyone dealing with an eating disorder to contact the National Eating Disorder Helpline. She also recommends a video the cast made called 9 Truths About Eating Disorders, which helps debunk a number of myths and misconceptions that the film doesn't tackle.)
Still, others in the ED community have given the filmmakers their support, arguing that To the Bone stands to do more good than harm by simply existing in the world. Kristina Saffran, co-founder of eating-disorder support charity Project Heal (which has partnered with the filmmakers to help "guide them on how to have this conversation in a responsible way") says it would probably have been impossible to make a realistic movie that wasn't triggering to people with eating disorders, because "when you're dealing with an eating disorder, literally everything is triggering." While Project Heal has said they do not support Collins's weight loss — and their involvement with the film took place after the fact — Saffran suggests we should "take [Collins'] word" that she is in a better place after the shoot and that it was actually therapeutic for her to go through this process.
Even if Collins hadn't lost weight for the part (and some of the film's more harrowing visuals were the result of prosthetics), eating-disorder therapist Carolyn Costin — who moderated a panel on the film alongside Collins and Noxon, in partnership with Project Heal — thinks that critics would have found fault with the film's method no matter what. "I think you have to take the basic understanding that you can't have a film about a troubling topic without troubling some people," says Costin. In her view, the absence of realistic representations of eating disorders onscreen means that any attempt to do so faces a disproportionate amount of scrutiny.
"I've been racking my brain, what would be the alternative?" Costin asks. "If you're going to make a realistic movie, I don't have an alternative. if you took an actress who wanted to portray someone with anorexia and they tried to lose weight, you could risk that person getting an eating disorder. And if you took someone to play Marti's character and you kept them at a normal weight, I think you'd be accused of glamorizing the eating disorder because nobody would see anything bad."
Some of this comes down to the different schools of thought on whether you can ever be fully recovered from an eating disorder, which Costin believes is possible. "[Where] the philosophy [that recovery is lifelong] comes from is more like a chemical dependency where people would say 'you can never have a drink because your chemistry is different,' and that's not been proven in eating disorders," she says. "People do this all the time, lose weight, gain weight, smoke, put themselves in compromising positions, yet there's something about the eating-disorder field where people get very upset about it," she says. (In an op-ed, Costin said she too was "was concerned and unsettled upon hearing the leading actress had suffered from anorexia in the past yet lost weight to play the part." Still, she adds, "the important thing" is that Lily has recovered and did not relapse.)
Lost amid all the consternation over eating-disorder pathology and triggering imagery is the question of what it means for an actress like Lily Collins — or a filmmaker like Marti Noxon — to revisit her own traumas onscreen. Plenty of art has been born out of individual suffering, and it's clear from Collins' memoir that she sees being an advocate and an actress as two sides of the same coin. Her weight loss was, in its way, an attempt to access some sort of autobiographical truth — even if doing so threatened to put her back in the path of the same dangers she sought to communicate.
"My experience helped me be able to tell Ellen's story in a true and genuine way, which benefited not only the character but also myself," Collins told The Cut via email. "If I didn't feel I was ready to take on this role, I wouldn't have. But I knew in my gut it was for a greater purpose than just my own healing." She continued:
"In preparing for the role I wanted to pay tribute to the suffering 16-year-old girl I once was and portray a young woman in her situation as best I could, tapping into the mind-set but also keeping a fine distance for the woman I've since become. I chose to help tell this story, one woman's story in search of recovery. Every single person's journey is different. As was mine."
In her book, she writes about how taking the role was by no means an easy choice, about the fear that she wouldn't be able to separate herself from the role or resist old triggers, as well as her struggles post-shoot, filming Okja in South Korea, where isolation from friends and family and a lack of familiarity with the food presented potential triggers for relapse. And she writes about how, ultimately, she took the part — along with all the risks it entailed — because she felt it was a creative and ethical obligation to bring her story to a wider audience.
"I remember driving home the night we wrapped filming on To the Bone and passing my high school where many of my insecurities, relationship problems, and eating issues had begun," she writes. "I looked out the window and smiled. Little did I know that the troubled Lily back then was going through it all for a greater purpose. To one day share her story as part of a much larger one. To have her voice join the voices of so many other young women. It's a weight off my shoulders, a self-inflicted burden relinquished."