Representing eating disorders in film

Award-winning actress and filmmaker Dr Parvinder Shergill discusses her latest project, TWELVE, a film on eating disorders. You can also find more information on the Faculty of Eating Disorders, anorexia and bulimia and eating disorder resources and reports here on our website.

Transcript

Ella Marchant: Hello and welcome to the Royal College of Psychiatrists' podcast with me Ella Marchant.

Cases of eating disorder sadly rose during the pandemic and according to NHS Digital, show that the number of under 20s admitted to hospital due to an eating disorder has risen 50% higher in 2021 than in previous years 2019 and 2020.

Speaking on her latest film Twelve, which delves into the recovery stage of an eating disorder, is Dr Parvinder Shergill.

Parvinder is a BAFTA recommended, award-winning actress, filmmaker, and psychiatrist working in the NHS, she makes it her mission to represent as much diversity on screen as she does off screen, working with people from various backgrounds in both the cast and crew of her productions. Her stories have shown a wide range of mental health needs and Twelve is no exception.

Parvinder Shergill: Twelve is a short film about eating disorders recovery set in a anonymous group. And it follows the journey of Raveena, who's a British South Asian, young female, going to the group and meeting a diverse group of service users sharing their stories. And it's written and directed by Molly Vandermeer, produced by myself, and I'm starring in it as well. So, on one side of my career, I work in films, that might be in writing, directing, producing, acting, podcasting, pretty much anything. And then the other side, I'm a registrar in mental health in London in the NWL.

EM: Something quite big that you're covering in the film, is how eating disorders have been affected during the pandemic? And what might be the reasons for the increase in eating disorders during the pandemic?

PS: Yeah, I think during the pandemic, I think mental health has certainly been hit, whether you're a staff member or a service user, or you've never seen services before for your mental health. You know, for very obvious reasons, with eating disorders specifically, I do think it's one thing, it's multivariable, and multifactorial. So, if we kind of look at it, you know, education has been really impacted, whether you're at school, college or university. If you're an older person working and also having a postgraduate education, it's been really effected for people. And with eating disorders. Sometimes for people, it's the way of controlling a situation in a chaotic life.

So, if we think about the pandemic, I think a lot of us have felt out of control, we don't know what the future holds, we're still sort of in it. And especially earlier on, there was a lot of uncertainty financially, what's happening day-to-day, with our loved ones, funerals, weddings, school, jobs, etc, where we're living. For many people, it was a way of controlling that. And if we think also, for people that have - we're on lockdown having to stay home, that can be quite triggering for people. If we think about certain things for individuals, that could have been a lot of family and measurement, they could have been a lot of people at home at the same time, people could have had their own mental health issues.

If you've had eating disorders before, mental health before, that increases your risk as well of relapse, if you know, things are triggering you. And being surrounded by that at home on a day-to-day can be quite stressful. And if you think about food, food was impacting a lot of people, you know, I mean, you'll talk to your friends and colleagues and peers, and they'll say I've put on weight during COVID, or for others, it's gone the other way. I say food has, you know, it's one of the things that we always look out for as psychiatrists, we ask about sleep and your appetite. So, that's certainly been impacted for people. And also, a lot of people have been online during this time and social media use has really gone up in screen time.

I think that visual content coming in day-to-day and if your self-esteem was quite low already about your body image, social media might have played a big impact on that and possible eating disorder problems that you might be having.

EM: So, do you think through people spending more time at home, people are you know, maybe perhaps looking in the mirror more on Teams, on Zoom? Do you think people have become more hypercritical?

PS: I think certainly is something that we need to think about. Because a lot has changed. Again, it's not one thing, I think it's a combination of these different things and being around you know, if you think about being home for some people was really stressful. And some people don't get on with who they're living with.

Not having that routine, you're used to or seeing your peers. Being locked away at home having a fridge there, possibly using screen time, if you've had to Zoom it can be quite overwhelming for people and sort of out of the ordinary and out of their comfort zone.

I think just people are different, different things trigger different people and different things stabilise individuals, but certainly. That sort of uncertainty as well about the future and kind of what's going on can it have increased anxiety and possibly that's why - one of the reasons that increase their eating disorders.

EM: And you've touched a little bit on what the film is about, that the main character is going to a support group. Could you tell us a little bit more about what it's about and why it's so important?

PS: Yeah, so 12, I think is so incredibly important because it's essentially about eating disorders recovering. If we think about film and television, you don't typically see the film industry tackling eating disorders after a diagnosis. Normally, you see a character, for example, going through an arc, or some sort of journey, where they get the first symptoms of an eating disorder and get diagnosed or something very dramatic happens, they might be hospitalised or something. Whereas this particular story is actually focusing on what happens after you've had an eating disorder. And you're on your way to recovery, which I've personally never seen in film. So, it was really important one to show that aspects, I think there's a lot of stigma in the film industry about not tackling issues of mental health after you've been diagnosed rather than before, and trying to get the help. So that was one aspect.

Secondly, it was on the rise during COVID, globally, and we wanted to really emphasise that and also this particular film, because it has so many diverse characters. We've got two black actors, we've got myself, a South Asian actor, we've got an East Asian actor, we've got a plus size, we've got an LGBT individual, we've got a disabled character, we've got pretty much someone where somebody could relate to themselves if you're watching. So, it's so incredibly diverse and inclusive, which was really important, because if we think about any film, or mental health, you get all walks of life coming through the door. We really wanted to represent that

It's not just an eating disorders, it's typically stigmatised that you're a Caucasian teenager female, and we wanted to show that actually you can be anyone, you can be an older person, and have eating disorder issues, you can be a man, you can be someone of colour, you can be from a different ethnicity. We really wanted to tackle that taboo, as well as in the film industry side, I'm so excited to say we had about 22 women in cast and crew and only about eight male cast and crew, which is a huge thing in the film industry, because it is very male dominated. We really wanted to tackle so many different taboos here, we wanted to give women, you know, a fighting chance in the film industry, we wanted to obviously tackle mental health eating disorder, which is on the rise, and obviously give that opportunity to so many different people. And we really hope especially the NHS does such great work and the Royal College, but we really wanted to show people it's actually okay to continue the road to recovery and still get help after you've been diagnosed, and to kind of show people what that's like. And it's not as frightening or anxiety provoking as people might think.

EM: So, you've already mentioned a very diverse cast in the film, but who worked on the film, and why is this relevant to raising awareness for mental health?

PS: Yeah, so we're really lucky actually, we had quite a few named British actors that wanted to be part of it. We had Lesley Ash, who's works with BBC, we had Ali Bastiaan, who was in Hollyoaks. And we have Duncan James, who some people might remember in the band Blue, and he's also in Hollywood. So, they were actually part of the film. And myself and Molly Vandermeer, who's the writer, director. Molly and I had worked together before, and we were talking about working together again. And we really have the same passion. So, it's about raising awareness of mental health, giving women the opportunity. And for me, obviously, as someone of colour, it's very important that we have lead roles of actors of colour.

We were just talking and Molly had this script, actually, from three years ago, I think it was on a laptop, because she had a few personal stories about eating disorder with those actually knows. So, it came from a place of somewhere of heart for her. And for me, obviously, working in mental health, as a doctor, I'm always incredibly passionate about this and trying to spread awareness in a different way, but in a cinematic platform, so we're really lucky. And we also had Ghana, who was our DOP. So, our cinematographer, and she's actually BAFTA and BFI. We actually had a BAFTA editor as well.

We had really incredible females as part of this film who have been part of the film industry, and we've had a lot of support actually, from the newspapers because I think this is something very different because we have filmmakers, and we have NHS staff joining forces here. And we had NHS consultants coming on set doing COVID testing for us. They have been invited to the premiere. We've had a lot of support. We've been interviewed by The Sun, Daily Mail, Variety Magazine, so it's getting a lot of traction on both sides. And that's what we really hope with this film that on one side, you know, it does go forth in the film industry and hopefully reached BAFTA and Oscar. And, the other side, we hope it makes a difference, you know, globally with mental health and it really helps to spread that awareness and also that stigma from mental and helps raise awareness for the NHS staff what they've been doing.

EM: That's incredible. Also, in fact, you've got Duncan from Blue, I absolutely loved him.

PS: No, I was really happy. Actually, I was dying for him to be in it. So remember, do you remember as a little girl, listening to Blue, I was really excited for him to be part of it.

EM: That's amazing. That's such an inspiring cast, like both in front of the camera and in the crew as well.

PS: Yeah, no, it's amazing. I feel really honoured to be part of this film genuinely like on the side night.

EM: So, you really want to not only, obviously, you want the film to have success, but you also really want this to educate people.

PS: Yeah, I mean, the big thing for me is, you know, coming into the NHS, I'm really honoured to work here. But I feel, for many people, I've always felt that we need to move with the times, it's not the same as it was in the generation above us, not everyone is happy to come speak to a stranger in a clinical room that might feel a bit cold to them, and tell your problems, that we have to move with the times.

And I think the pandemic has shown people and clinicians that we can't just justify educating people behind clinic doors we have to reach people's home, it's very difficult for people to get to services there's a long waiting list. And I think we need to be a bit practical and realistic. And that's not me saying anything bad about the service, it's just looking at a problem head on. And you know, and during the pandemic, What have people done, even staff have done it, you've watched more to film, you've watched more TV, you've listened to podcast, radio, you've used other resources. And I think we need to also move with that we need to adapt.

When we're educating people, we can't expect them to come here. Because people take time out of their lives and in the financial crisis, not everyone can afford to do that. So, instead of people's health, suffering, why don't we- it's free, you know, it's cheap, why don't we educate, but make it creative, through song, through dance, doing music, through podcast, radio. Reach out to people globally, where they might struggle to get to a service? And why don't we start at a young age - go to schools, do that? Why in film, one thing, I always say we have status, but why don't we have mental health first aiders? Why don't we use film? It doesn't matter where you are, you could be in Peru, you could be in India, you will have access somehow to film. You know, I've been trekking in Peru and they had it in the jungle, people somehow get hold of film and TV.

So, why not use that platform and cinematically so educating people without them even realising they're watching something really interesting, but without realising passively, they're absorbing the signs and symptoms for mental health. We need to be a bit smart, be a bit more flexible, a bit more creative, and how we're reaching out to people. And I think children, you know, children now have iPads, they have phones, it's very different to when I was growing up, so why not stimulate them and make them learn without them realising, have books on mental health that are fun and colourful. Have TV shows for children that are about mental health, and they will then hopefully grow up in a generation where it's okay to talk about their mental health and get to get the help and to recognise the earliest signs and symptoms recognise, they catch it earlier, and hopefully won't have, you know, severe mental health. I think we need to move with the times and also think about the future of the NHS and how we can best support it. So, I think it is really important, and that's my, that's what I want to do in the film industry.

I want to kind of create that, and break down that barrier and create that bridge between mental health, as we do traditionally use it, as a doctor, but then incorporate that and film industry and create them together and a partnership, because I think there's something very powerful there. And I think that is the future.

EM: Absolutely. I think it's really, really difficult for especially young people to seek help independently, like say they don't feel comfortable speaking to their own parents or they don't feel comfortable speaking at school. They don't know what mental health resources are out there. But what they do have is, you know, access to Netflix, and they've got the internet so you're right, it's kind of, in a way, easier for them to consume this kind of content.

PS: You know, Instagram, everyone's got some sort of social media, whether it's WhatsApp, Twitter, Instagram, TikTok. I think we'd be really foolish not to use these resources, of course, like what you're saying, it needs to be the right information. It needs to be safely done by professionals. But we have to also think, who our target audience and actually it's not just the elderly population, it's children. It's young people, young adults, and you have to think how did they best get the information they want?

They're not typically going to look at a leaflets you know, those days are gone. I think that we need to think how are they going to consume information and people binge at the moment, so why not give them information that's interesting for them to consume but the correct information.

EM: It would be good if teenagers and young people could consume content that was, in a way entertaining and engaging to watch but also educational.

PS: And I think you've raised a valid point, I completely agree. And, I myself, I've made it Amazon series where it's a psychological thriller. So, it seems out of the ordinary for mental thought. That's another thing I was thinking about in the film industry, I think they need to be educated as well, because they actually have the power here, which doesn't make sense to me if they're not also talking to professionals

So, I think they need to liaise with the professionals, we need to liaise with them, because they're the people that have the power globally to spread this awareness actually. And I think, the film industry a lot when I'm in it, people don't realise you can make a very beautiful film. And it doesn't have to be dramatic. And I mean, when I say dramatic, you don't have to have a patient with mental health with a knife stabbing everyone, or you don't need to have a patient who is raging psychotic or something. Because that doesn't represent the day-to-day. The representation of day-to-day is you and me. It's people just suffering, quietly, because we all have mental health, and you're getting through it day-to-day, and that might to some people not be that exciting to watch. But that is the normality, and we need to make cinema norm more normalised actually. And there is a field for that.

It’s about working with the film industry and working with podcast and radio and seeing what's best that we can do, but also making it interesting, but not sort of out of the ordinary mental health.

EM: Yeah, I don't think most people realise that people who have mental health needs are much, much more dangerous to themselves than to other people. Because whenever we watch violence, it's always kind of motivated by someone being crazy or psychotic. It's quite damaging.

PS: It's incredibly damaging. And what people doing with people fail to realise I think it's only like 5%, actually, is if you've got tendency of being an angry or aggressive person to actually be violent. And if you've had that history, I mean, that's a really low percentage. What about the rest of the percentage? There's a lot that needs to be done. But I think now's the time, do you want I mean, the pandemic has shown people what they're doing. Let's embrace it, let's not fear it. Let's move with technology.

And I think we have, it's an incredible position to be actually in mental health and to be able to have, Wi-Fi at your fingertips, we have a lot of power. And we have, you know, I just think the future is very bright with technology. So, I think we need to just embrace it with both hands.

EM: Absolutely. What kind of projects would you like to work on in the future?

PS: I've done a few films now. So, I've worked with a couple of platforms, you know, BBC sky, Amazon, I think I'd like to move on to kind of bigger projects, more TV series. Now for mental health, I think I'd like to tackle that. I've only done film, really, or theatre. And so I think next for me next year is looking at TV series and seeing if I could work more with the Royal College with NHS. I just made my first NHS documentary with rehab, actually, which was really exciting. So, all the cast were service users and all the crew were NHS staff, which was a really exciting way for everyone to get involved.

So, I like to continue that as well, as well as kind of getting to bigger platforms with my film. So I've been BAFTA recommended this year. And so next year, I'd really like to try and get to the Oscars with mental health film, so I don't know. We'll see. But I'm aiming quite high.

EM: You've had so much success already though so I feel like it's not really aiming high, it's just aiming like, a little bit higher.

PS: Oh, no, no, but that's very kind. I think there's a lot more I want to do. And I also feel just as someone of colour, I feel there's a lot more that needs to be done and for women as well and industry. So, I want to keep going until I feel I'm satisfied, but I'm not quite there yet.

EM: And in terms of covering mental health needs, you've covered so much in the work that you've done postnatal depression, eating disorders, and is there something else that is kind of underrepresented? Do you think that could benefit from being more than spotlight?

PS: That's so interesting, yes, I've done a few things I've done, sort of obsession and love trauma, PTSD, assault, as you said, postnatal depression, pregnancy, perinatal care, and yeah, I've done eating disorders. I think there's a lot in psychiatry, I'd love to explore actually, I'm always very open. There's always an interesting story in whichever, sign or symptom or diagnosis, or syndrome. I'd love to explore the idea of culture bound syndromes. I think that's not been done. And what I mean by that is like exploring different cultures like the Japanese mental health culture, the Egyptian mental culture, I think that would be really fascinating. Not just audiences, but also just educate oneself, there's, we're not educated a lot actually, as clinicians about different cultures, and how they view mental health, you know, like the Jinn.

I know, in my culture, how they've human health is very different to Western culture compared to east. I think that'd be really fascinating. Also, I think audiences would find that fascinating. There's a lot of themes you could do with that, like thrillers or drama, or mystery. I think that would be quite exciting. So maybe one day.

EM: Yeah. So, it's not just necessarily mental health news that you want to explore. It's actually how other cultures view mental health needs?

PS: Yeah, because I think, you know, I always think about myself, like, I am very lucky, I've been brought up in two cultures and the way Western east and how we view is very different. And I think if I didn't have that sort of sensitivity, and I saw somebody who was saying something that I know, my aunt would say, I think, Okay, I think you have schizophrenia, but actually, it's a culture, to think in certain ways, and to have certain beliefs and faiths, and it's not a diagnosis.

So I think that would be really interesting. And I think, you know, in the UK, we have absolutely, every is amazing, we have so many different people from different places. And I think we need to be a bit more open to that, and learn a bit more and learn what their remedies are. And kind of rather than thinking the Western way, is the only way and to explore that. And I think also just, you know, with everything that's happened, Black Lives Matter, you know, the Asian hate, I think, just for globally for people to also be aware of other households and kind of how they thinks we don't know, we don't know, we have our stereotyped image and what we think but we don't know how and why they think like this, because it also comes down to sort of ancient history, I think would be really fascinating. And I think people will be much more accepting of other people rather than rash making rash decisions.

And I think it would also really help also not having to jump straight to medication, but to think of sort of other, you know, platforms and other ways to sort of manage patients, if you understand more about them. And you know, why they think like that and where they've come from. There's just so much and that's the beauty of mental health.

You'll never get to the bottom of it, I think always keep developing and changing and there's always a story or find, and that's why I think it is the future of film because you know, if you watch every film, there's always mental health in there without people realising you'll always have a lead character going through some sort of anxiety arc. There'll be a gunshot, there'll be some sort of trauma. They'll there's always something, but I think it's just picking out sort of very interesting background stories never seen before. And then it doesn't have to be dramatic with a gunshot or, the lead character. It can actually be a fascinating subplot going on. But yeah, I find it I just I find it very exciting.

EM: Huge thank you to Dr. Parvinder Shergill for discussing her latest project Twelve, which will be released next year. You'll find information on the Faculty of Eating Disorders, anorexia and bulimia and eating disorder resources and reports on our website, which is www.rcpsych.ac.uk. Thank you for listening to the Royal College of Psychiatrist podcast with me Ella Marchant.