Q&A: 'Thin' Director on Anorexia

Award-winning photographer Lauren Greenfield has spent her career using the camera to explore the effect of culture on women's bodies. But when Greenfield visited the Renfrew Center for the Treatment of Eating Disorders in Florida, she was unprepared for the depths some women will sink to in order to get skinny. Her new documentary "Thin" follows four women (Alisa, 30, Brittany, 15, Polly, 29, and Shelly, 25) on their emotionally and physically fraught journey through rehab. The film premiered on HBO Tuesday and will be repeated on the channel in heavy rotation. NEWSWEEK's Raina Kelley spoke to Greenfield about this troubling topic. Excerpts:

NEWSWEEK: You've spent much of your artistic life focusing on the impact of prevailing culture on female bodies—weddings, proms, tattoos, etc. What was so different about this project?

Lauren Greenfield: When I started, I had no idea what an eating disorder was. I thought it was a disease that spoke to society's ills. And I definitely didn't understand it as mental illness. But when I got there, I dove in and it became my life for a couple of years. In the film, you don't get the sense of the outside culture. Alisa described having an eating disorder as being in a tunnel. They never talk about boys or celebrities.

America is the fattest country in the world. Why are we so fascinated with anorexia nervosa?

I think it's two things. Like I said, when I started, I was looking at eating disorders as a symbol of what's wrong with our culture—using the body as a canvas. I thought of it as a very extreme example of how women speak through their bodies—very much out of the mainstream. And then I found that it was hard to meet someone who hasn't been touched by this disease. It has really surprised me. I didn't really know the statistics [1 out of 7 women have or do struggle with an eating disorder] when I started and then many more have what they call disordered eating or some kind of unhealthy relationship with food. And the symptoms look so normal to us in our culture—dieting, exercise and looking good. So many of the girls I worked with say that in the beginning stages of their illness, they got positive reinforcement. On one hand, society thinks, "What's the big deal? It's just a diet that went too far." But on the other hand when you see that it's an illness that can kill you, you start to ask, "What's the line between healthy and sick?"

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What were some of the risk factors you saw in the girls you worked with that pushed them over the line?

In the film, you see a lot of triggering events that I wanted to just hint at because it's not that simple. Lots of people also have parents that get divorced and they don't get an eating disorder. The media tends to simplify causality into one or just a few things. But I definitely think media depictions of women are a strong trigger, but it has to combine with other things to produce an disorder. I try to show as many moments like that as I can in the movie so people can see how personal history triggers combine with genetics, family dynamics, culture, personality to make a person develop this disorder.

Women with eating disorders are often portrayed in popular culture as controlling perfectionists. Did you see that?

I think it's most important to see it as mental illness. Lots of those characteristics that you mentioned are part of the illness. They are searching for control in an area where they can get control. That said, a drive for perfection and obsessive compulsions are also risk factors for eating disorders. You can see that in the women in the film and that's why I connected with them. Alisa is someone who had a good job as a pharmaceutical rep. The year she went to treatment, she missed several months of work and was still Rep of the Year. But she said that she struggles to find satisfaction in her other achievements and said, "I just want to be thin. If it takes dying to get there, so be it. At least I'll get there."

What's the one thing people need to understand about this disease?

People need to see that you would never choose this. People don't have a choice about it. You need to want to quit starving. I think that's why Shelly agreed to do this. Her therapist asked her on the first day [of her treatment], "Why are you going to let yourself be followed by a camera?" And she said, "Because I want people to know." He pushed her and said that's kind of a general answer and then he said, "Who do you want to know?" And she said, "My Dad." She thought that if her family saw other women going through this, they'd understand her struggle better. Three of the women came to Sundance with me. They got a lot of positive feedback during the Q&A's after the screening and they felt very validated, like they'd done a good thing to prevent more women from aspiring to anorexia.

Why are eating disorders so hard to treat?

People do get better. It's my understanding though that you get better over a period of four to seven years and insurance won't cover that. Plus, this is a very difficult population to deal with. It's an illness that thrives on secrets and lies. They're manipulative and they'll be the first to admit it. I commend the people that help them everyday, they're heroes.

How cooperative was the Renfrew Clinic where the documentary was filmed?

I've worked with them for a long time. I photographed there in 1997 for a magazine and then again for my project "Girl Culture." They began to understand my background and where I was coming from and we built up trust. I brought this proposal to them two years before we began filming and we developed it together with HBO. When we worked on the film, I met with patients and staff and administrators to develop a process where everyone felt OK. We had a consultant on hand who once had been a patient and a staff member there who people could go to if they felt uncomfortable. No one had to be filmed.

DANGEROUSLY THIN Director on Eating Disorders Families Fight Insurance Cos. New Thinking About Anorexia Live Talk: Director Takes Questions How long did the documentary take to film?

We filmed for 10 weeks over a six-month period. I had a room there so I could sleep there if I felt it was important.

Have any pro-anorexic people reached out to you?

No and on our Web site's forum, we've been screening out that kind of content because as one anorexic woman told me, "We don't know how to use our voice so we're using our body." My intention was to show the reality of this disease even while knowing that these details can trigger or can teach anorexics something they didn't know. But, all that information is already out there. If they want it, they can find it. I wanted to tell the story as truthfully as possible. For people who don't know this world, they need to know how bad it can be. That said, I didn't put in all the details if they didn't add anything to the stories.

Did you expect your documentary to spotlight the lack of insurance coverage for this type of illness?

Yes, actually I did, but I didn't know if I was going to be able to get it on camera, which thankfully, I did. There were women on the phone everyday at the clinic begging for one more day of treatment. Polly's downturn came when insurance said they weren't going to cover her. And Brittany was making progress and when she found out that she had to leave, she began spiraling downhill. I hoped it would come up and it did.

Did you expect to see the kinds of changes in the women that you did?

Yes, it's one of the few mental illnesses that have a physical manifestation. Shelly saw herself get a better personality as she gained weight. That's what she noticed when she saw the film, and it gave her inspiration to get better.