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July 2011 Posts

04/07/2011 14:49:21

Sharing the Secret

Introduction

Sharing the Secret was made as a television drama in the United States in 2000 and first released in the UK on DVD in 2003. It received a Peabody award in 2001 for the accuracy of its portrait of a teenager in crisis. Directed by Katt Shea, with perceptive performances from its cast, it explores the subject of bulimia nervosa in a high achieving teenage girl, Beth, whose parents divorced a few years earlier. Offering a wonderful platform for a discussion about eating disorders in general, it could also be used to explore the differential diagnoses that may be associated with the symptom of binge eating. Of additional interest is the fact that Beth’s mother, Dr Nina Moss, is a child psychologist who treats children suffering from emotional difficulties as a result of divorce but who is unable to detect the early signs of emotional difficulty in her own daughter.

Sharing the Secret

The Film

The film opens with teenager Beth having breakfast in a restaurant with her father John, who is remarried and has a young son.  Beth excuses herself to go to the toilet, looking tense and upset. We next see her in the flat, where she lives with her mother Nina, as Beth is doing homework w ith a friend. Her mother comes home hungry that evening and is unable to find a portion of Chinese food that she had stored in the fridge. Beth tells her that she had thrown it out because the smell made her feel sick. Nina comments to Beth that she has grown ‘tall and skinny’ and Beth replies that she likes looking that way. These first few minutes set the scene for the story that unfolds, introducing the suspicion of something secretive about Beth’s behaviour concerning food and that she has a particularly acute focus on her own body image.

Beth is a bright and able student who has a passion for ballet. She is struggling to fit in with her peers, who are all preoccupied to some extent with their body appearance and the world of dating. At a friend’s party, Beth actively sabotages the approaches of a boy and in the following scenes she is seen to avoid eating, always giving a seemingly plausible reason for her abstinence, until we are eventually shown her binging secretly on a large amount of food before making herself vomit.

Her father wants to integrate Beth more fully into his new family and invites her to stay over at his house for a weekend, something that she has not done since his remarriage. In a particularly poignant scene, during the first sleepover, her father tells Beth that she is gorgeous and then says “I wish I’d frozen you at 10, you’re growing up so fast”. Beth, clearly upset by this, denies that she is growing up. In contrast, Beth’s mother does not have a new partner but works long hours as a child psychologist. She and Beth appear to have an overly close, loving relationship in which Nina even shares certain details about her patients. Indeed, Nina’s therapy sessions with one young girl, Rachel, are shown in some detail. The film portrays Nina’s attempts to ‘give Rachel a voice’, to express the difficult feelings she has in her father’s newly blended family. This storyline contrasts brilliantly with Beth’s reality in which her parents seem to have worked hard to avoid any openly expressed negative emotions about their separation, although animosity simmers just below the surface. This, in turn, has left Beth trying hard to please them both with her compliant behaviour and high academic achievements.

Beth’s secretive bulimic behaviour finally comes to light as her physical health deteriorates and she collapses at school. Forced into therapy by her mother, Beth initially rebels but then begins to engage with the therapist, allowing her to acknowledge her illness. It is only then that she asks for some inpatient help, as she recognises the need to get some distance from both her mother and her father. In a brilliant scene between Beth and Nina, in which Nina describes the shame and guilt that she is having to bear, Beth shouts out angrily “ It’s not about you....it’s about me”. The film ends with Beth beginning to make progress in the inpatient unit but with more still to achieve, viewers must decide how they feel about her future.

Relevance to the field of Mental Health

As a clinical case study, Sharing the Secret presents a very good portrait of bulimia nervosa and provides an excellent presentation of some of the underlying psychological issues that may play a part in the genesis of an eating disorder in the teenage years. The film also offers an opportunity for discussing the difficulties that may be encountered in trying to engage sufferers in any form of psychological therapy.  Sharing the Secret could also be used for teaching students about the wider effects that an eating disorder, in one family member, can have on others in the family. In particular, it explores the painful struggle of a mother who is forced to cope with the guilt she feels about failing to recognise her own daughter’s eating disorder.

There is a useful, detailed discussion on the topic of bulimia and binge eating in an article by Zaffra Cooper and Christopher G. Fairburn, in Advances in Psychiatric Treatment (2009) 15: 129-136 entitled Management of bulimia nervosa and other binge eating problems (abstract). This article was a revision of a paper by Christopher G. Fairburn with the same title, published in Advances in Psychiatric Treatment (1997), vol. 3, pp. 2-8, now freely available in its entirety. Beth clearly presents the three cardinal features required for the diagnosis of bulimia nervosa; frequent binges of large amounts of food; the use of vomiting, fasting and or exercise to control shape and weight, and, lastly, an extreme focus and concern about weight and body shape, indeed a fear of being fat, bound up closely with a low self-worth. All of this occurs without excessive weight loss.

Further information can be found on eating disorders at the Royal College of Psychiatrists website as well as a leaflet on anorexia and bulimia. The  NHS choices website has a good short video featuring consultant psychiatrist Professor Janet Treasure, from the eating disorder unit at South London and Maudsley NHS Trust, discussing bulimia.

CBT for the treatment of bulimia nervosa has a good evidence base and there is an interesting article discussing the use of CBT for a variety of conditions when working with young people and their families, entitled Cognitive-behavioural therapy with children, young people and families: from individual to systemic therapy in Advances in Psychiatric Treatment (2010) 16: 23-36 (abstract) written by consultant psychiatrist Nicky Dummett.

With its excellent portrait of an eating disorder in a teenager, I would definitely recommend Sharing the Secret to anyone interested in working in the field of child and adolescent psychiatry regardless of their discipline. This film may also be of interest to sufferers and their families.

•   More information about Sharing the Secret can be found at IMDB.

•   The DVD can be purchased at amazon.co.uk.

•   Minds on Film is written by consultant psychiatrist Dr Joyce Almeida

 

 

 

 

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About this blog

 

Minds on Film is a monthly blog that explores psychiatric conditions and mental health issues as portrayed in a selection of readily available films.

Please note that this blog may contain plot spoilers. Any views expressed are purely my own.

Dr Joyce Almeida

Dr Almeida is a consultant
psychiatrist working in the private sector in the UK.

 


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