Thin (2006)

Film Review by Jenny Barley, UBC Faculty of Medicine and
Harry Karlinsky, MD, MSc, FRCPC, Clinical Professor, Department of Psychiatry, UBC

USA 2006, Director: Lauren Greenfield

The cultural mainstream in Western society is one where the ideal is thin and being overweight is often interpreted to represent a loss of personal control. The 70 per cent of women and 35 per cent of men who are dieting at any given time demonstrates our preoccupation with body image.

Almost two per cent of young women have anorexia nervosa and three to five per cent have bulimia nervosa. Over 10 per cent of those with anorexia nervosa eventually die from its complications, making it one of the most lethal of all psychiatric illnesses.

Awareness of eating disorders is increasing and film appears to be a particularly effective medium capable of heightening our understanding of these devastating disorders. A number of moving documentaries and fictional films revolving around individuals with eating disorders have been produced over the last decade.

Perhaps the most infamous is the Todd Haynes directed Superstar-The Karen Carpenter Story (now precluded from public release due to unattained musical clearances). Fortunately, there is also now the documentary Thin.

In 2006 its director Lauren Greenfield took a candid look at the lives of four young women coping with anorexia as they received treatment at The Renfrew Center, a Florida-based residential treatment facility. It is a remarkably intimate and unflinching portrait.

For six months Greenfield follows four young women as they each receive inpatient treatment at The Renfrew Center. Fifteen-year-old Brittany wants nothing but to be thin. Shelly, a 25-year-old psychiatric nurse arrives at Renfrew with a feeding tube, which she admittedly uses to purge. Alisa, a 30-year-old mother of two, battles a relentless life-threatening desire to lose weight. Polly, 29, battles not only her anorexia, but also the rules and the staff at the treatment centre.

Consumption with illness tolls relentlessly on these women and their interactions with food, family, staff and one another. Greenfield captures group sessions, body image therapy, meal times, weigh-ins and family meetings. The viewer learns that Brittany’s mother also suffers from an eating disorder, and that Alisa joined the Air Force solely to lose weight. As unique as each character’s story might seem, the mass preoccupation with body, size and shape is alarmingly similar in each account.

Manipulation, deceit and mistrust are also common to the relationships between the patients and the staff. Polly is the ultimate malefactor when it comes to following Renfrew’s rules leading to an inevitable discharge at the end of the film. One is left wondering how much of this woman’s malevolence is truly her own versus to what degree such behavior is intrinsic to the disorder itself.

Greenfield effectively enlists the viewer to imagine how these maladaptive characteristics might actually be (knowingly or unknowingly) aiding and perpetuating the illness. Ultimately, Thin features four women who use their physical selves to exert control, express anguish and portray identity.

Thin is Greenfield’s first feature length documentary. The film was premiered at the Sundance Film Festival in 2006 and was nominated for an Emmy for Outstanding Direction in 2007. Her photographic reportage, also titled Thin, was honoured by the 2007 International Photography Awards.

The critical reception for Thin has been both positive and negative. Clearly the strength of the film is the intimate access it provides to an illness shrouded with secrecy.

Although the director manages to get remarkably close to the women being treated, Greenfield fails to draw in the world outside of Renfrew—perhaps deliberately to represent the isolation that captures and holds these women. As a result, the viewer doesn’t leave the film with an understanding of why these women are sick, nor does the film suggest that the women themselves are any more enlightened than the audience. To paraphrase one reviewer, Thin is descriptive, rather than explanatory, but perhaps there’s no need to apologize for this deliberate penetrating stance.

Thin is also a useful counterpoint, albeit brutal, to those who might otherwise underestimate the seriousness and chronic nature of anorexia nervosa. The viewer is exposed to a variety of treatment interventions of which most of the lay public, and perhaps even general psychiatrists, would be unfamiliar—such as room searches conducted with the military precision of a SWAT team. This appears to be entirely in keeping with the oppressive and adversarial atmosphere that permeates the facility. An even greater adversary is the American insurance industry, harmfully and prematurely limiting treatment for a significant percentage of patients.

A brief update is provided on each of the four women at the end of the film. The most positive outcome appears to be for Polly, who has found meaningful employment in a photography studio. Tragically, we now know that Ann ‘Polly’ Williams recently committed suicide on February 8, 2008.

It’s clear the potential mortality of eating disorders needs continuous communication, and Thin serves as an unforgettable and effective reminder of the lethality of these disorders.