Women driven to the edge of skeletal

Polly Williams was 29 years old when she slashed her wrists twice and downed a bottle of sleeping pills. What drove her to the edge? Two pieces of pizza. She hadn’t been able to get home in enough time to throw them up.

Williams, one of four women with life-threatening eating disorders whose stories are told in the documentary film “Thin,” came to the Sundance Film Festival with first-time filmmaker Lauren Greenfield, the acclaimed Venice photographer who has explored in often shocking images the relationship of girls to their bodies.

“I remember being so devastated that my body was digesting the pizza, and I couldn’t handle it anymore,” said Williams during a joint interview with Greenfield here.

The documentary, filmed in a South Florida clinic for women with eating disorders, which will air on HBO in the spring, grew out of Greenfield’s 2002 photo book “Girl Culture.”

If nothing else, it is an unflinching portrait of a deadly mental illness that is little understood and poorly treated. Each morning’s weigh-in sessions are an exercise in horror and hope -- it’s not uncommon for the women in treatment to weigh less than 85 pounds. A two-pound weight gain, while medically laudable, is met with disgust by one of the patients. “This is such a horrible disease,” Williams said. “It’s not something you can beat on your own.”

Among the three other subjects in the movie is Alisa Williams, who joined the Air Force at the height of Operation Desert Storm because she thought a military regimen would help her lose weight. Before entering treatment, she tried to keep her calorie count to 200 a day (U.S. dietary guidelines recommend at least 1,600 calories daily for women) and compulsively changed clothes into the wee hours looking for something that made her look thin. Asked to draw an outline of her body on a big sheet of paper taped to a door, she produces an image that looks more like an NFL linebacker than the petite creature that she is. “This is the one thing I want -- to be thin,” says Williams, the single mother of two small children, “so if it takes dying to get there, so be it.”

Shelly Guillory, a psychiatric nurse, purges through the gastric tube that was inserted to save her life. Competitive with her identical twin, Kelly, she tells her therapist that “if I get bigger than her, that’s the end of me.”

And Brittany Robinson, a depressed teenager who went from 185 to 97 pounds in the space of a year, talks about the bags and bags of candy she and her mother would buy for “chew and spit” parties. “We just had fun. We didn’t think it was a problem, which, obviously, it was.” When Robinson arrives at the clinic, she has liver damage and her hair is falling out.

Although eating disorders are often treated lightly in the popular culture -- “a glamorous illness that movie stars get,” as Greenfield put it the other day -- her aim is to show that “it’s not coming out of vanity or to look good in jeans, but a very serious mental illness that’s incredibly hard to treat.”

Greenfield received extraordinary access to the patients at the Renfrew Center, as well as access to staff meetings, therapy sessions and “community meetings” where angry or tearful confrontations would sometimes occur. At mealtimes, the nausea and despair is palpable. These women do not want to eat.

Greenfield was nervous about working in the collaborative world of film but was encouraged to pursue the project with producer R.J. Cutler by Sheila Nevins, president of HBO’s documentary division, on the basis of some taped footage.

“In photography, I am my own boss and do my own thing,” Greenfield said, “but I think I had a dream situation for my first film.” The only advice Nevins gave, she added, was a suggestion to stay within the walls of the center and not follow the subjects home after treatment is completed.

“I told her to stay in one place, to bore a hole,” Nevins said before the film’s premiere here Saturday. “I was interested in the whole rehab situation -- the expense of it, the survival rate, the professionalism of it.”

It is that question -- the professionalism of the staff at Renfrew -- that provides some unexpectedly troubling moments on film. There are many compassionate professionals (some of whom are obese, an odd juxtaposition), but there are moments that are cringe-worthy -- when, for example, a mental health professional calls Polly Williams a “bad seed” because she is the dominant member of a high-spirited threesome of patients at the clinic. (They smoke in their rooms against the rules or get a tattoo during a furlough instead of perusing a bookstore.)

Room searches for contraband items, such as cutting tools or cigarettes, and Draconian rules contribute to a sense that the patients, who already seem like little girls (their chests are flat and many have stopped menstruating), are infantilized further by the clinic protocols.

“We have a long way to go in the professional treatment of psychiatric disorders,” said Nevins, who said the film was a revelation to her. “I grew up thinking that anorexia was a Vogue magazine disease -- you flipped the page and you wanted to look like that. I didn’t know it was a neurological dysfunction, a mental disease. These children, young women, need psychiatric help and pharmaceutical help, not just rigorous bootstrap philosophy.”

The movie raises, but does not explore in depth, the limits of insurance coverage that exacerbate some patients’ problems. Three of the four have insurance issues. Two leave Renfrew before they are ready. “More concretely, the film is about anorexia and bulimia,” Nevins said, “but symbolically it stands for parity for mental illness to other diseases. To put time limits on the treatment is ridiculous. You don’t put a time limit on cancer or diabetes.”

According to doctors with whom Greenfield consulted for the film, it takes an average of seven years to recover from an eating disorder. “And most insurance,” she said, “covers three weeks.”

Nor does the movie plumb the causes of anorexia and bulimia, which are complex and not well understood. In a conversation here, Polly Williams, now 31 and the manager of a portrait studio in Chattanooga, Tenn., said that when she was 11 years old, her mother and aunt paid her $200 to lose 10 pounds. Her mother was her coach, she said, imparting techniques that became second nature: “Mom was like, ‘A plate of spaghetti that’s covered in sauce, think of it as live worms sitting there on your plate and somebody wants you to eat it.”

Williams has been in two intensive outpatient programs since leaving Renfrew two years ago. She is in the care of a therapist and a nutritionist and has forced herself not to pay attention to the numbers on her scale.

In the movie’s epilogue it becomes clear that all four women on whom Greenfield trained her unflinching eye are facing a lifelong struggle.

One tried to commit suicide after treatment, one immediately lost 17 pounds, and one left the clinic saying she didn’t want to be helped. Even Williams, who seemed to have the happiest ending, has setbacks.

“I may go three months and never purge,” she said, “and then something may happen and you have a lot of stress and you have three days where you just purge, purge, purge. And then you pull yourself out of it.”