Review of HBO Documentary "Thin"

Several weeks ago, I had the opportunity to watch Lauren Greenfield's film "Thin", which is available through Netflix. (You can watch a portion of the movie online at the site I just linked). The documentary followed, without narration, four eating disorder patients at the RenFrew inpatient facility in Florida. It was a sadly realistic picture of inpatient therapy, and through interviews and observation of the women's behavior, gave insights into the mindsets of young women with bulimia.

The film is, to my knowledge, the only one of its type - the camera follows patients at the facility to daily weigh-ins, is present during group therapy, and is even rolling during patients' private consults with staff nutritionists and psychologists. Although Renfrew is not a locked facility, this portrayal is much more in-depth and nuanced than a day program or outpatient meeting could be.

After a few statistics on the screen, alerting us to the fact that 5 million Americans suffer from eating disorders, the camera pans to the facility's nurses' station, where "meds" are dispensed in little paper cups to each of the patients, who dutifully shuffle up to the window. Next, we see a nurse handing two cigarrettes each to patients (presumably their daily "smoke ration").

Since Renfrew is not a Christian or even integrationist center, I need not critique too thoroughly the obvious differences between secular psychology and the biblical worldview present in this one simple scene. I will note, however, that psychtropic drugs have no effect on eating disorder patients, other than to make them dependant on the mood-altering effects (well-illustrated in the film by the character Shelly), and using tobacco to stuff one's feelings or "deal with stress" is simply swapping one chemical dependency for another. I have written many thousands of words on these from the biblical position, and will not re-open the issue now, as Renfrew does not claim to follow biblical principles. I only cite the obvious.

Next, the camera follows two adult residents - long-time casualties of inpatient treatment - as they go out to the "smoke porch" to gossip about staff. Shelly, a psychiatric nurse in her late twenties, has been anorexic for over a decade, in and out of many hospitals, takes too many prescription meds to list, and has a feeding tube implanted in her stomach (which she uses to purge). Polly, a thirty-something bulimic, chain-smokes and seems to enjoy "alliances" and intrigues among other residents. She seems to enjoy the drama connected with her "illness" and when confronted with immature behavior, heads to the toilet to purge (on-camera) at the tail end of her treatment. The bathrooms at Renfrew are not locked. “I was counting calories and fat grams by the time I was eleven”, she reveals in an interview.

The film also follows a 15-year-old girl, Brittany, who was an overweight child and became bulimic to lose weight. Ironically, she seems to handle herself with more maturity than older residents. We learn that her mother also has an eating disorder and the two of them used to purge together. When the mother visits Brittany, we see her picking at the food on her tray and refusing starches, even though her daughter is prescribed a certain number at each meal by the in-house dieticians. We sense, early on, that Brittany's chances for recovery after discharge are minimal.

The fourth featured patient is a 30-year-old mother, Alisa, who recounts her daily fast-food run and subsequent purge ritual in an interview. Alisa truly desires to leave bulimia behind, for the sake of her children. Tellingly, she states, "I tried so hard to find satisfaction through other accomplishments, but nothing measured up to this one [being thin]. So a couple of years ago, I just thought, ‘So be it. If it takes dying to get there, so be it. At least I’ll get there."

This is a women deeply in need of Christ, but she will never find Him at Renfrew.


"Thin" skillfully portrays rehab culture without commentary. The fact that the modern "psych model" is completely entrenched in these young women's minds is self-evident. The over-arching trait that seems to define the women - who range in age from early teens to late thirties - is that of self-pity. The environment seems to foster competition as to who is the sickest – even while beseeching one another for “support" at group therapy meetings. The viewer gets the uneasy impression, especially while watching the childish, rebellious antics of the older patients, that they enjoy the attention a little too much. The very environment seems to breed immaturity by setting up parent/childlike dependence roles.

When two of the patients who have achieved a higher level of privileges are granted a day outside the center, they lie to staff about their whereabouts and head to a tattoo parlor (forbidden by the rules). Once there, they complain about Renfrew's staff "trying to make them fat" and revel in their silly antics. (These are women in their thirties). Several times, while watching these women flout the rules, smoke in the bathrooms, and criticize the staff in the style of junior-high schoolers, I wondered rhetorically, "Why are you there?"

The inherent drama breeds a tattle-tale culture. Staff and residents alike seem to thrive on drama – later in the film, after food is found hoarded and it is blamed on the wrong person, Shelly and another resident very dramatically report that they have knowledge of the two who went to get tattoes. Contraband prescription drugs are found during a room search, given to another patient by the cavalier Polly, and she is asked to leave the program. After many tears and a "revenge purge", she leaves.

None of the patients appear particularly devoted to heart (or attitude) change, although the staff, for their part, genuinely seem devoted to helping them "recover". They appear committed, principled, and compassionate - vitally important characteristics for those working with eating disordered patients (as well as all addictions). When Polly is expelled, an orderly who has come to know and care for her embraces her in the hallway and lets her cry on her shoulder - asking her to stay in touch. Polly's defiance and continual manipulation has led to her being removed from treatment; but she is not beyond the touch of human kindness. It was a tender moment, and made me wish Polly had received more hugs and soothing words in her childhood so her adulthood would not have been spent "playing" mental health staff. The RNs, nurse practitioners, program directors, nutritionist and psychologists genuinely want to help the girls, but their best efforts are thwarted by the girls' own rebellious natures. It is clear that they are offering the best they have - the world's "wisdom" as espoused by secular psychology.

When the two patients rat out their fellow residents for getting tattoes, the program director commends them by saying, "I give the two of you a lot of credit for being willing to go there, and I think you just need to stay in that space." I have no idea what that was supposed to mean, but it reminds me of what Richard Ganz would call "psychobabble".

Repeatedly, in the obligatory group therapy meetings, aberrant behavior is addressed by emphasizing the negative effect defiance has on “The Community”. The mantra of "group" is that "The Community" can only be as well as it’s members (an almost cult-like thinking); yet paradoxically, the role of personal responsibility in overcoming one's eating disorder is never directly addressed in appointments with the psychologist. They women are repeatedly told they have an "illness", and they have come to believe it. The "addict as victim" mindset has taken over. But they must not disrupt "The Community".

One of the film's most compelling, realistic look at eating disorders through the eyes of sufferers is a group scene towards the end. Fifteen year old Brittany is about to be discharged, and tearfully admits she doesn’t want recovery. A 28-year-old and 30-year-old graphically recount to her what the last decades of their lives have been like with bulimia (since they were 15), and assure her it’s not worth it to be thin. She is discharged anyway, as insurance would not pay for further treatment. She predictably began restricting again, and lost weight rapidly.

ALL of the characters followed in the film relapsed badly after discharge. Even those who were not re-admitted continued to struggle with purging and restricting. A month after leaving Renfrew, Alisa (the 30-year-old bulimic) meets up with Shelly after the latter is discharged for a celebratory meal. The camera follows her home, where she vomits. The film’s post-script says that Alisa lost 20 pounds after discharge and attempted suicide by overdosing on diuretics. Shelly, the 25-year-old featured on the film’s cover, quickly lost the 17 pounds she had gained while an inpatient. According to the epilogue, she underwent electric shock therapy to treat her depression.

The documentary very accurately showed the true picture of eating disordered thinking and the best the psych fields have to offer. Proving my thesis many times over, "Thin" only reinforced what every nouthetic counselor and every Christian set free from an ED has long known: true heart change and restoration is only possible through Christ. Behavioral and clinical psychology is the best this world has to offer, but its answer is a spiritually empty substitute and a pretension that sets itself up against the knowledge of God (2 Corinthians 10:5).

After watching this movie, I longed to look up all of the featured patients and share the hope of Christ with them. If anyone else has viewed the film and has thoughts they wish to share, please do so.