Should we trust Apple with mental health data?

Here are some cursed words: “Apple Plans AI-Powered Health Coaching Service, Mood Tracker and iPad Health App.”

I can see why you might say, Liz, this sounds benign and obvious. What’s the big deal? And I think about a meeting I had in 2014 with a freelance writer who was wearing three fitness trackers, inadvertently imitating Madonna’s 1980s stacked bracelets look. He asked me how I slept. I was — and am — a pretty good sleeper. I snooze heavily for seven to eight hours and wake up feeling good, sometimes even before my alarm goes off because I am (sorry) a morning person.

The freelancer I’d been speaking to, perhaps obviously, had been having trouble sleeping, and as someone who was fairly devoted to optimizing his life through fitness tracking, he’d been troubled by his subpar sleep. I still believe he might have slept better if he’d taken those trackers off — because one way to ensure you’ll have a bad night of sleep is to worry you’ll have a bad night of sleep. Putting pressure on yourself to sleep well often backfires.

A year later, Apple introduced the Apple Watch. Moving into the health space made sense — then, as now, healthcare costs in the US were growing and were expected to continue to grow. Apple has gotten bolder about its health efforts, too. As recently as last summer, CEO Tim Cook has repeatedly said that the company’s “greatest contribution” will be to people’s health. Apple is not alone in trying to get involved in healthcare: Amazon announced acquisitions of PillPack in 2018 to get in on prescription medicine and of One Medical to get in on doctors in 2022.

Now, the new coaching service — codenamed Quartz — sounds like an expansion of the Apple Watch play from physical health to mental health, Bloomberg reported. It is “designed to keep users motivated to exercise, improve eating habits and help them sleep better” using “AI and data from an Apple Watch to make suggestions and create coaching programs tailored to specific users.”

While Quartz may not come to market at all, I think looking closely at the experience of the Apple Watch is important because that provides us with a sense of what to expect.

About five years ago, I wrote about the various ways that the Apple Watch failed as a behavioral intervention. There’s some behavioral science, but also — because I was using it — I discovered that the constant nudging for achievement made me miserable. I began to think of it as my failure bracelet.

It is half a decade later, and none of that has changed. There are no rest days. The default notifications are all switched on in attention-shattering ways. And while I was test-driving the watch all those years ago, I got guilt-tripped for being sick, an experience I repeated in January when HealthKit told me I was moving less than usual during a week in which I was laid out with covid and during the weeks I spent recovering from it. 

Still, a lot of people like the Apple Watch, and even I — once I switched off pretty much all the notifications — have found it useful. (Being able to instantaneously find my phone? A gift, I am forever losing that damn thing.) I’m harping on the default settings, though, because most people don’t change them, and for people like me, they can create destructive patterns.

The general impression I get from the default settings is that the Apple Watch’s ideal customer is a neurotic mess, highly judgmental, and unable to relax. The other general impression that I get is that whoever is making these design decisions at Apple is desperately in need of some gold-plated therapy. 

I bring up therapy because Quartz is meant, in part, to track emotions. This is a real cause for concern. Think for a moment about the person who wants to track their emotions the most — perhaps someone vulnerable, maybe with mental health issues. Do you think a pressure-laden notification nightmare is going to make that better or worse? Consider the freelancer counterproductively stressing about his sleep — only now imagine that for every feeling.

Besides, many of Apple’s ideas here involve digitizing things that are already available to you cheaply or for free. There’s the proposed “journaling service.” A very effective journaling service already exists. It is called a notebook. You can buy one for like $2 at a drugstore, or for more money if you feel fancy, and you can even put stickers on it. And the VR meditation headset? I know “touch grass” is an online insult, but it’s also not bad advice: you can always go outside and feel better. Somehow, I don’t think a VR headset encouraging mindfulness is going to be more effective than lying on your back in a park and watching the clouds roll by — not least because the clouds aren’t going to make you nauseated.

I’m emphasizing non-screen interventions, particularly for health, because I’ve been watching what happened with research on social media: it makes people feel bad. I love computers (duh, I write online), and I love the stuff people do for them. But I am increasingly convinced we need to get the hell outside because we are weird primates who evolved with outside, not computers. We also need face-to-face time, as we all discovered the hard way in 2020. If you want to feel calmer, happier, and more connected, I feel confident that the best way to do that is to log off. No AI can possibly replicate those needs because, as social animals, what we need is other people.

But even if I am wrong about that — and I might be! — I am still concerned by Apple’s notification approach and its science-blind approach to behavioral health. That 12-hour stand goal on the Apple Watch? Someone just decided that was important. There’s no research behind it, as Apple told me all those years ago, just vibes. The decision to track calories as the default for the Move goal is dangerous for people with eating disorders. The focus on streaks can create compulsive behavior. I am doubtful the subscription services are going to be any better.

Behavioral health interventions are notoriously difficult. They require a grasp of psychology, sure, but they also require a certain amount of flexibility because people’s lives are complicated. Apple’s ham-handed approach to physical health has been bad enough — the idea it is now going to approach mental health does not fill me with confidence. I’m sure there are plenty of people out there who won’t mind letting Apple toy with their emotions. But we’ve got a lot of evidence now that too much screen time is linked to bad health — and for Apple, its entire business is getting you to spend more time with its software and gadgets, not less.