“There’s a fine line between showing what it’s like, and also potentially crossing over into triggering territory,” says one eating disorder expert of the series’ depiction of Princess Diana’s illness
There’s a scene early on in the fourth season of The Crown, shortly after the 19-year-old, soon-to-be princess Diana (played by Emma Corrin), has just moved to Buckingham Palace. Alone and feeling abandoned by Prince Charles in the cold, gilded recesses of the palace, she is buckling under the pressures of public life and fighting with her (correct) suspicions that the relationship between Charles and his friend Camilla Parker Bowles is more than platonic. Anxious and isolated, she sneaks downstairs to the kitchen in the middle of the night. She opens the door to the fridge and starts grabbing desserts one by one. The camera then cuts to the soon-to-be princess of Wales in the bathroom, retching.
The scene represents a dramatic shift in the portrayal of Princess Diana, the globally beloved royal and philanthropist who died in 1997 at the age of 36 in a tragic car accident. But to anyone who’s ever struggled with an eating disorder, it’s eerily familiar. Feeling rejected by the royal family and tightly constrained in her new role, Diana tries to regain control of her circumstances the only way she knows how: by binging and purging. In a later episode, she does it again after an argument with Prince Charles during a tense tour of Australia and New Zealand, and is seen curled up on the bed in shame afterwards.
Bulimia nervosa is an eating disorder characterized by episodes of binge eating that are later followed by compensatory behaviors aimed at preventing weight gain, most commonly vomiting, explains Evelyn Attia, professor of psychiatry at Columbia University Irving Medical Center and director of their Center for Eating Disorders. Though it affects an estimated one to two percent of the female population (men are also affected, though not as commonly), it was little understood and often lumped in with anorexia until the late 1970s, when academic literature began to emerge about the subject.
The portrayal of Princess Diana’s eating disorder is one of the most gripping aspects of the season, notable in part for how explicit it is: Diana is seen hunching over the toilet, regurgitating her food, a position that would be unthinkable for a princess. To depict Diana’s struggles sensitively, Netflix, which has previously faced criticism for glamorizing disordered eating, brought in a UK-based eating-disorder recovery organization to consult on the series. Episodes that feature the behavior are also preceded by a trigger warning stating they contain scenes that some viewers may find “troubling,” as well as a link to a website for those looking for resources and information.
Despite these efforts, some eating disorder experts are concerned that the blunt depiction of Diana’s bulimia may be difficult for those in recovery to watch. “It’s really tricky to portray eating disorders in the media. There’s a fine line between showing what it’s like, and also potentially crossing over into triggering territory,” says Chelsea Kronengold, communications manager at the National Eating Disorders Association (NEDA). Kronengold would’ve preferred that Netflix focus less on the specific behaviors associated with Diana’s disorder — the binging, the purging, etc. — and more on the impact it had on her life.
By contrast, other experts, including Melissa Gerson, founder and clinical director of Columbus Park Eating Disorder Center in New York, hailed The Crown as a chillingly accurate representation of what it’s like to live with bulimia. “The way they present Diana’s struggle really highlights some of the factors that can be central to people who struggle [with eating disorders],” says Gerson. “One of the maintaining factors and triggering factors is the isolation she experienced. They really accentuate how alone she was. Also, it’s just a reminder eating disorders come in all shapes and sizes. Even with someone who is very slender and attractive and seemed to have everything, it’s always eye-opening to be reminded that behind the scenes the reality may be different.”
Diana went public about her battle with bulimia in 1995, during a much-publicized BBC Panorama interview. “I had bulimia for a number of years, and that’s like a secret disease,” she told BBC interviewer Martin Bashir. “You inflict it upon yourself because your self-esteem is at a low ebb, and you don’t think you’re worthy or valuable. You fill your stomach up four or five times a day — some do it more — and it gives you a feeling of comfort. It’s like having a pair of arms around you, but it’s temporarily, temporary. Then you’re disgusted at the bloatedness of your stomach, and then you bring it all up again. And it’s a repetitive pattern which is very destructive to yourself.”
At the time Diana disclosed the issue, few celebrities had ever publicly discussed their experiences with disordered eating, let alone their recovery; one of the few examples was Karen Carpenter, who died at 32 due to complications from anorexia nervosa. “There was clearly not as much awareness as there is now,” says Gerson. “There wasn’t awareness of how many people really struggle with bulimia.” Diana’s revelation that she had been bulimic, and that she had successfully recovered from the illness, sparked a huge spike in diagnoses of eating disorders, which the National Eating Disorders Association (NEDA) later termed “the Diana effect.”
The fourth season of The Crown ends in 1990, therefore does not depict the impact Diana’s brave admission had on the general public, which may be addressed next season. More troublingly, though, it doesn’t go into detail regarding her recovery from the illness, which began in the late 1980s. By the end of the fourth season, as she and Charles’s begins to dissolve, she appears to have gained some control over her behaviors, hunching over the toilet to vomit only to suddenly stop herself. But the show doesn’t follow the treatment that got her to that point. “I would always recommend that the impact of treatment be part of what is included in any portrayal of eating disorders,” says Attia. “We want to show recovery is possible. We want to show those types of outcomes. They’re important, they inspire people, and they educate people.” She points out that research shows that psychotherapeutic interventions, such as cognitive behavioral therapy and antidepressant use, have been proven to serve as effective treatments for bulimia nervosa.
But even though this season of The Crown may fall short in some respects, it ultimately does a service to survivors and those at risk of developing disordered eating behaviors by showing the daily horrors of the illness and the devastating effect it had on Diana’s own life and family. “Overall, I do hope portraying the realities of these conditions helps people understand what they are and helps them understand they’re not alone,” says Attia.
If you are struggling with an eating disorder, NEDA has a toll-free confidential helpline staffed by trained volunteers. Visit Nationaleatingdisorders.org/helpline for more information and resources.
This article originally appeared on <strong>Rolling Stone</strong>