"Society's to blame, the world is so unfair... I have to die," are the first words out of Ellen's mouth. She's in art therapy at an inpatient facility, tearing down another patient's struggles with magazines. She continues, "There's no point in blaming everybody. Live with it."
This is the first glimpse of Lily Collins' edgy character in Netflix's 'To The Bone', a film that, before it's even been released on the platform, has stirred up quite a bit of controversy due to its depiction of eating disorders.
The film, set to release this week on the streaming service, follows Ellen as she battles anorexia nervosa. Netflix's description calls it her "harrowing, sometimes funny journey of self-discovery". When the trailer for the film was released many were concerned with the explicit depiction of eating disorders, but Netflix stood by the project, claiming that the film had always intended to start an important conversation.
CEO of The Butterfly Foundation, Christine Morgan, spoke to HuffPost Australia about the film, and the Foundation's specific concerns around it.
"One of the aspects of an eating disorder, particularly if you have anorexia nervosa, is at a time in the illness you are looking almost 'do it better'," Morgan told HuffPost.
"There is a real vulnerability to copycat behaviour, so if you are suffering from an eating disorder and you see graphic representations of what somebody is doing or has done there is a very real risk of copycat behaviour. It's not a logical choice somebody makes, they're driven to it."
Another vulnerability, according to Morgan, is a genetic risk. Particularly when framed around a "life affirming illness to go through and come out the other end", individuals can be triggered into an eating disorder by graphic representations.
"We've been provided to see the film, and it's extremely graphic. Our concern is that people be alerted to the fact that there are potential trigger points and if someone feels vulnerable, they should reach out for help."
Butterfly, along with Mindframe, spoke with Netflix representatives and discussed adding trigger warnings to the film itself.
"We stressed that Australia has very robust, well-developed and evidence based guidelines around how to report on mental health issues and, in particular, around eating disorders. We told them it is unsafe if we don't put trigger warnings, and if we don't provide people with direct links to where they can get help. We haven not heard from them."
A spokesperson for Netflix said there would be no comment regarding trigger warnings for the film.
Collins has been very vocal about suffering from an eating disorder, and even wrote about it in her book 'Unfiltered'. In January she shared an Instagram image with a caption celebrating the film's premiere at Sundance.
"What a huge moment this is for me," the caption read. "Owning my past, being open, and having no shame or regrets about my experiences. Sharing my history with eating disorders and how personal this film has been is one of the most fulfilling experiences of my life."
It's a complex issue, with Collins speaking about how she had to lose weight to play the role, speaking about doing so in a "healthy" way. The entire narrative is weighed down in potentially triggering notions.
Similarly, the film's writer and director Marti Noxon spoke out about her own experiences with eating disorders. In a statement released by Netflix, Noxon said she had not set out to glamorise eating disorders.
"Having struggled with anorexia and bulimia well into my 20s, I know firsthand the struggle, isolation and shame a person feels when they are in the grips of this illness... My goal with the film was not to glamorize EDs, but to serve as a conversation starter about an issue that is too often clouded by secrecy and misconceptions."
Morgan said she could see where Noxon was coming from with this goal, but that it wasn't enough when it comes to potentially triggering content.
"We have an estimated 1 million Australians in 2017 with an eating disorder, but less than 25% are engaged in treatment. One of the primary reasons many are not engaged in treatment is the very high levels of stigma."
"At Butterfly we support the concept of trying to raise awareness across all levels of community about the reality of this being mental illnesses. They're not properly formed, they're not lifestyle choices, and when you're in the midst of them they're an absolute hell. I accept you can't do that without portraying an eating disorder either verbally or any other way. I can understand that and indeed to an extent support films or other means of communication that raise awareness.
But it's critical, it's imperative that if we're doing that, we're doing it in a way which is responsible to all of our community and in particular our young people."
-Christine Morgan, CEO The Butterfly Foundation.
Noxon worked with survivors as well as consulting Project HEAL (Help to Eat, Accept and Live), the largest eating disorder nonprofit in the United States, but at this stage, Netflix has yet to comment on their plans to add helpful resources to the film.
"What trigger warnings do is putting into real time, just as you're about to watch something or have just watched it, a little alert which says 'If you find this confronting, if you find this difficult to cope with if you feel uncomfortable' or if it's a parent who's watching it who says I feel uncomfortable, then go to see an expert."
"A trigger warning to the extent of 'be careful, this could hurt you,' is like one arm of the coat hanger. It's not enough. You need to have a trigger warning and then somewhere someone can go for help."
Netflix's model, being instantly accessible to audiences over a variety of devices, makes things even more difficult for young, impressionable audiences. The streaming service was recently criticised with its series '13 Reasons Why', which graphically depicted sexual assault and suicide.
Netflix responded by adding extra trigger warnings to the series after mental health advocates complained against the series' strong content.
Morgan also noted that the release of 'To The Bone' aligns with school holidays.
"Those normal mechanisms we would have for alerting teachers and school communities -- we would have sent something out but obviously we're in school holidays. It's extremely disappointing to me."
"Start the conversation about eating disorders," Morgan said, "I can see merit in that. But don't do it without putting a clear direction for people who, if they feel vulnerable or uncomfortable or distressed in any way -- tell them where they can go for help."
"If you want to raise a difficult or confronting topic for discussion, then put the safeguards in place."
If you or anyone you know are overwhelmed, concerned or needing support you can contact Butterfly's National Helpline on 1800 33 4673 (8am–9pm AEST, MON – FRI) or Lifeline on 13 11 14 for 24/7 support.
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