To The Bone: Should You Watch That New Eating Disorder Movie?



The release of To The Bone, an original feature film on Netflix about a young woman with anorexia nervosa, has generated a lot of attention. Is it triggering? Is it thinspiration? Should you even watch it?

As a mental health provider who works with people with eating disorders, I watched the movie with a critical, but not dismissive, eye. I cannot recommend the movie to anyone who is actively in treatment for an eating disorder, or who is not 110% secure in his or her recovery. Parents and family members who are very close to the treatment process might also choose to skip viewing this movie, if only to avoid the pain of seeing your own battles reflected on screen.

If you choose to watch To The Bone, please keep the following caveats in mind:

This is not a film about eating disorder treatment. If you seek treatment for an eating disorder at a residential facility, please don’t expect it to look like the cozy bungalow in the movie. Your doctor will not drop the f-bomb. You will not be unsupervised at meals or allowed to make out in the backyard. In order to bring the viewer inside the minds of people with eating disorders, writer and director Marti Noxon has her characters share their thoughts with each other. Out loud. At the dinner table. While this dialogue elevates To the Bone, please know that if people speak to each other that way while in a treatment facility, those conversations happen on the sly, or are expressed privately in a journal or a therapy session.

This is not a film about how people recover from anorexia nervosa. It highlights reasons why eating disorder recovery can be elusive. It shows why support from people who understand what you’re going through really matters. But support can take many forms, and a romance between the lead character and the only eligible young man is one of the film’s limits. I have seen intense, meaningful bonds form between eating disorder clients. Romance needn’t enter the picture for an encounter to be transformative. Often these treatment-born friendships are volatile, fragile, and fraught with strong emotions. Yet these same relationships can provide a type of support unlike any other. Often they are the first way that a person in treatment recognizes that he or she is no longer truly alone.

This is not a documentary about what it’s like to have an eating disorder. It’s a fictional depiction of one (young, white, upper-middle class, educated, intelligent, artistic, angry) woman’s struggle to choose recovery over starvation. The narrow focus, informed by Noxon’s own experience with anorexia as a young woman, is at the heart of why the film feels authentic. Sure, the film gives a nod to other genders, ethnicities, and diagnoses, but telling those stories too would result in a very different movie.

Whether or not you choose to watch To the Bone is entirely up to you. The good news is the film is stimulating more open discussion about eating disorders, which may explain part of the reason that organizations including NEDA [National Eating Disorders Association]  and Project Heal have partnered with the film’s creators to promote it. But watching this film is not the only way to keep the dialog going. Read some of the 1200+ responses that readers of the New York Times Well blog generated in response to its coverage of the film or pick up a copy of Life Without Ed by Jenni Shaefer.

Did you watch the film? Did you choose not to watch it? Please share your thoughts in the comments section.

Emily-1

Emily Becker, LMSW, is an EWN therapist who believes that it’s the strength of the relationship you create together that generates meaningful change. Emily strives to greet each session with a curious mind, an open heart, and a wish to hear your story. This Fall, Emily will be leading Reach For Recover, a support group for anyone committed to eating disorder recovery. Contact her directly at 716.400.1605 | ekbeckerlmsw@gmail.com

 

Know Thy Selfie



22068562203_ccf6cffb64_kIn my last post I wrote about the importance of checking in with yourself emotionally; however, emotions are only one piece of self-awareness. “Know thyself,” asks a bigger question. This bit of wisdom from ancient Greece is often attributed to Socrates, but is likely even older, and was reportedly carved into the Temple of Apollo at Delphi.

Does self-knowledge still matter?

Knowing oneself has always mattered. But a lot has changed over the past 2500 years, so this desire shows up today in ways that Socrates never could have imagined.

Consider the smart phone. According to a recent Pew Research Center survey, 77% of adults in the United States own a smart phone. Only fifty years ago, we all talked into identical black telephones with cords, without Caller ID or voice mail. In contrast, the smart phone’s ability to make mere phone calls isn’t the secret to its success. These palm-sized devices often become a miniature hub-of-self, comprising a person’s entire identity.

No part of the smart phone better represents our interest in self-knowledge than the camera, with which one can snap, save, edit, and then inevitably share, a selfie.

We have the ability to curate an endless number of carefully crafted images that shape the identity we choose share with the rest of the world. Selfies represent how we want to be seen by others. They do not show that we truly understand ourselves. We need look no further than the popularity of Snap Chat filters (even the puppy one) that smooth skin and widen eyes to prove this point.

I’ve got nothing against selfies. They’re fun. But they direct the desire to be known outward when it can go inward as well.

Self-reflection: a selfie for the soul.

The wish to know oneself becomes less daunting if you admit you don’t need to have all of the answers. Sometimes acknowledging mixed feelings about a life choice is a necessary first step to make if you want to make a change such as drinking less coffee or getting more sleep.

Whether you tackle self-reflection alone or work with a therapist, begin the process with a few simple questions:

What am I thinking right now?
What emotions do I feel?
What physical sensations am I experiencing?
How do these three answers affect my behavior?

These questions riff on Dr. Aaron T. Beck’s cognitive behavioral model. Asking these four questions in a variety of settings, from the everyday to the singular, generates important information about how you respond to life’s ups and downs. Slowing down long enough to answer them creates an opportunity to learn, grow, and hopefully make the kind of decisions worthy of authentic celebration.

A celebration which will, of course, be captured with a selfie.

Photo credit: Roderigo Olivera

Mental Health Diagnoses & the ICD-10



October 1 looms large for us mental health and medical professionals in the US. From that date on we’re required to switch from using the DSM V or ICD-9 codes for illness to the International Codes for Disease tenth edition (ICD-10 for short).

This is already feeling like too much for a blog post so I’ll try to make my point fast.

If you are a consumer of mental health services the switch doesn’t change much of anything. Your treatment, therapy, medication and general care doesn’t change one bit. The ICD-10, like the DSM V, is a code that is primarily used for third party payment claims, like for insurance or medicare. That’s it really, but if you have questions ask your behavioral healthcare professional.

If you’re a mental health professional I suggest you start by referring to your specific local, state or national professional organization for guidance, the American Psychological Association, American Psychiatric Association, National Association of Social Workers, the American Mental Health Counselors Association to name a few. The good news is that the DSM V did most of the heavy lifting for us so that conversion from DSM V to ICD-10 for mental illness diagnoses is fairly seamless.

The good health care professional makes sure everyone from the direct care provider to the billing manager is up to date on stuff like this. Even if it is a pain in the patootie.

The Shooting at Fort Hood & Mental Illness: “Please God, Not Again!”



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Photo courtesy of Steven V

As soon as I saw the “Breaking News” my heart sank. Another shooting. Another gunman. More dead, injured, traumatized.

Then I brace myself for those two little words that always accompany these disastrous gun-related events: “mental illness.”

In a story on NPR, reporter Melissa Block spoke with Counselor Annie Powers, a military veteran herself,  who specializes in treating PTSD. Ms. Powers sees military patients at the Adult, Child and Family Counseling Center in Killeen, Texas, the town where Fort Hood is located.

Ms. Block reports, “All the patients [Annie Powers] talked to since the shooting have been talking about it.”

Ms. Powers states, “I can see where they might be concerned about, oh great, everybody thinks that if you have PTSD, anger, anxiety and depression issues that you’re crazy! There’s a lot of people who are afraid to come get the help. They don’t want it on their military record. They don’t want to go on medication because somebody might know, ‘I couldn’t handle it. I wasn’t strong enough.’ I have to explain to them that PTSD is not about strength.”

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Sleep sweeps away the garbage in the brain



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Eiko Ojala

Owning your own business can mean working 24/7. I really felt it last week. Even though I thought I was doing a good job with self-care, last night was the first time I was really able to sleep deeply, well and for as long as I wanted. This morning I woke up so happy, loose and serene I almost talked myself out of it! Almost!

It started with, “Remember the back up of emails you need to get to, that conversation you have to have you’re not looking forward to, that report you have to write…” I could feel the good mood start to dissolve like sugar dropped in boiling water. Thank God I stopped myself.

Instead I stretched and told myself, “Today I am happy. I can get to that stuff and still be happy right now!” And I smiled.

As I sipped my morning coffee, basking in my sleep fulfilled afterglow, I read the front page article in the New York Times Sunday Review section: Goodnight, Sleep Clean and it sighted studies that explained exactly what I had just experienced. That’s pretty cool.

We’ve had a lot of articles here on the EWN blog about the importance of sleep such as “7 Tips to Improve Your Sleep!” and without a doubt we’ll probably have more in the future. Sleep is that important to our mental, emotional and physical health!

So go to bed, relax and remember that sleeping is not a waste of time. It is actually allowing a second shift of biochemical workers to get busy taking out the trash! Wishing you all a refreshing good night’s sleep!

Remember the Basics! Sleep!



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Editor’s Note: Nicole reminds us that we often forget about basic human needs such as proper sleep, nutrition and exercise. Deficits in these areas can have significant repercussions on our mind and body.

Sometimes I feel like there is not enough time in a day. I will stretch my bed-time to accommodate all of the projects that I want to finish. At the end of the day I am exhausted and feel accomplished but may be only left with 4 or 5 hours of sleep.

With all of the demands of this fast-paced, driven society I feel compelled to produce. The consequence however is less productivity, more anxiety and more body aches. With only 5 hours of sleep and over-stretching my mind and body’s capabilities every day, I cannot possibly be as productive a person as I think I am.

The next day I am tired. As weeks go by I might have more sick days because my immune system is compromised and overall I have more anxiety due to frustration from my decreased stress tolerance. These can all be relieved by maintaining healthy sleep habits.

The most powerful sleep habit that I have adopted has been to fall asleep and wake at the same time every day, yes even on weekends! As a result, I have been clearer headed, focused and energized. For me that was well worth waking up at 8am on Saturday mornings! If your interested in reenergizing and healthy sleep tips click here!

Blues or Depression? 8 Ways To Tell



380747916_5cdc54b030My senior year of college my Dad suggested I go to a therapist. He thought it might help me find some direction. During a hard college career that was interrupted by chronic illness, I changed majors three times, and still wasn’t sure what I wanted to be when I grew up. So I thought what the heck, I’d give therapy a go.

After a few sessions, Dr. Greenbaum said I was depressed. Well blow me down! I wasn’t sad or crying all the time. How did he figure I was depressed?

He explained that you don’t have to feel sad to be depressed. Sometimes being depressed meant the stark, cold absence of happiness, feeling ‘flat’ or ‘empty’. There is a condition called dysthymia that is a sneaky form of depression. Not as imminently dangerous as major depression, dysthymia lasts longer, two years or more, is as serious and sometimes even more debilitating than major depression.

Eight potential signs (lasting longer than two weeks) of any kind of depression are:

  1. Feeling helpless, hopeless, stuck, “What’s the point?”
  2. Loss of interest in activities that were once pleasurable
  3. Appetite or weight changes
  4. Sleep changes. Insomnia or sleeping all the time
  5. Agitation or feeling slowed down
  6. Loss of energy, fatigue, easily exhausted
  7. Strong feelings of worthlessness or guilt
  8. Concentration problems, indecisiveness, lack of focus

Dr. Greenbaum taught me that being diagnosed with a chronic illness hit me harder than I wanted to admit, even to myself. He helped me get my head out of the sand and start living again. You might consider finding a good therapist for yourself.

More on: The symptoms of depression and types of depression

and How to Find a Good Therapist

Photo courtesy of Ozan Ozan

10 Ways to Find a Good Therapist



2558420993_6a732b1b72 When we want to improve our bodies we pretty much know where to find
help. This time of year the gyms are full and the meeting rooms at
Weight Watchers are packed. But what do we do when we want to improve
our inner selves, our relationships, to find help with depression or
anxiety?

I want to assist you to find the right therapist because making the decision to find help is hard enough. Why should you have to get even more stressed out hunting for the right therapist? I can only imagine it’s like searching for a needle in a haystack. So here are a few tips:

1) Forget the yellow pages. A yellow pages listing is expensive so a lot of good people aren’t there. I’m not. Plus there is no regulation of who can list.

2) Ask a professional you already work with and trust. Your accountant, lawyer, dentist, physician – any professional you have a relationship with who honors your confidentiality is a good resource. These people all run businesses as well as provide services, as do many psychotherapists in private practice. They are well connected in the community and refer to each other all the time.

By the way, when asking anyone for a referral to a mental health therapist you do not have to go into the details of why you’re looking for a someone unless you want to. It’s enough just to say, “I’m having some problems and I’d like to consult a therapist about it. Do you recommend anyone?”

3) Ask friends or family members if they can recommend someone.

4) Use a known therapist as a resource. If you have a friend or a friend’s friend who’s a therapist, ask them. Therapists refer to one another all the time. They will understand that you don’t want to see them (for whatever reason, you don’t have to say) but you want a recommendation from them. In other words, even if it doesn’t feel right going to your sister’s therapist, if your sister really likes her therapist he or she could probably give you a couple of names of good, qualified therapists in the community.

5) Use resources at work. Many places of employment have what’s called an Employee Assistance Program (EAP). These services might be in-house or out-sourced but the purpose of EAPs is to provide emotional support and counseling for employees in complete privacy and as part of the employee’s benefit package. EAPs are often part of the Human Resource department so ask there if your company has an EAP and how to access it. Usually you would see a counselor at the EAP for a set number of sessions (no charge to you) and if you want to continue they will refer to a therapist in the community who will take your insurance.

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The Horror in Connecticutt



No words can describe the horror, anxiety and grief that devastates us upon hearing about the school shooting in Connecticut. Parents everywhere reach out to our children, no matter how old they are, hold them close and tell them how much we love them.

The DSM-5 & Me: 3 Reasons Why I’m a DSM Agnostic.



My first introduction to the Diagnostic Statistical Manual (DSM) published by the American Psychiatric Association (APA), was standing in the kitchen of my parent’s home and witnessing my father in full rant.

My Dad was a psychiatrist / psychoanalyst of the old school. Which is to say he was brilliant but also of his time. Which is to further say his fury was directed at the APA for taking homosexuality as a diagnosable mental illness out of the manual. It was 1973.

Hardly aware of what he was so upset about, I did hear him dramatically declare that he was withdrawing his membership to the APA. My Dad loved being a psychoanalyst / physician but he wasn’t that crazy (you should forgive the word) about being a psychiatrist. His prescription pad gathered dust as he focused on talk therapy. So his threat to quit the APA wasn’t idle but it wasn’t like he was giving up his beloved couch.

By the time I got to graduate school the DSM had gone through at least four more mutations. Partly because of my experience with my Dad but also because my Mom was addicted to the Merck Manual of Diagnosis and Treatment (in which every twinge or sore throat could become a sign of impending doom), I maintained a skeptic’s view of the DSM.

If the DSM really is the behavioral health professional’s Bible, then I was a doubting Thomas.

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