In truth, I didn’t pay a tremendous amount of attention to iOS8 until a post scrolled by on my Tumblr feed, which disturbed me a good deal: The new iteration of Apple’s OS included “Health”, an app that – among many other things – contains a weight tracker and a calorie counter.
And can’t be deleted.
Okay, so why is this a big deal? Pretty much all “health” apps include those features. I have one (third-party). A lot of people have one. They can be very useful. Apple sticking non-removable apps into its OS is annoying, but why would it be something worth getting up in arms over? This is where it becomes a bit difficult to explain, and where you’re likely to encounter two kinds of people (somewhat oversimplified, but go with me here). One group will react with mild bafflement. The other will immediately understand what’s at stake.
The Health app is literally dangerous, specifically to people dealing with/in recovery from eating disorders and related obsessive-compulsive behaviors. Obsessive weight tracking and calorie counting are classic symptoms. These disorders literally kill people. A lot of people. Apple’s Health app is an enabler of this behavior, a temptation to fall back into self-destructive habits. The fact that it can’t be deleted makes it worse by orders of magnitude.
So why can’t people just not use it? Why not just hide it? That’s not how obsessive-compulsive behavior works. One of the nastiest things about OCD symptoms – and one of the most difficult to understand for people who haven’t experienced them – is the fact that a brain with this kind of chemical imbalance can and will make you do things you don’t want to do. That’s what “compulsive” means. Things you know you shouldn’t do, that will hurt you. When it’s at its worst it’s almost impossible to fight, and it’s painful and frightening. I don’t deal with disordered eating, but my messed-up neurochemistry has forced me to do things I desperately didn’t want to do, things that damaged me. The very presence of this app on a device is a very real threat (from post linked above):
Whilst of course the app cannot force you to use it, it cannot be deleted, so will be present within your apps and can be a source of feelings of temptation to record numbers and of guilt and judgement for not using the app.
Apple doesn’t hate people with eating disorders. They probably weren’t thinking about people with eating disorders at all. That’s the problem.
Then this weekend another post caught my attention: The Health app doesn’t include the ability to track menstrual cycles, something that’s actually kind of important for the health of people who menstruate. Again: so? Apple thinks a number of other forms of incredibly specific tracking were important enough to include:
In case you’re wondering whether Health is only concerned with a few basics: Apple has predicted the need to input data about blood oxygen saturation, your daily molybdenum or pathogenic acid intake, cycling distance, number of times fallen and your electrodermal activity, but nothing to do with recording information about your menstrual cycle.
Again: Apple almost certainly doesn’t actively hate cisgender women, or anyone else who menstruates. They didn’t consider including a cycle tracker and then went “PFFT SCREW WOMEN”. They probably weren’t thinking about women at all.
During the design phase of this OS, half the world’s population was probably invisible. The specific needs of this half of the population were folded into an unspecified default. Which doesn’t – generally – menstruate.
I should note that – of course – third-party menstrual cycle tracking apps exist. But people have problems with these (problems I share), and it would have been nice if Apple had provided an escape from them:
There are already many apps designed for tracking periods, although many of my survey respondents mentioned that they’re too gendered (there were many complaints about colour schemes, needless ornamentation and twee language), difficult to use, too focused on conceiving, or not taking into account things that the respondents wanted to track.
Both of these problems are part of a larger design issue, and it’s one we’ve talked about before, more than once. The design of things – pretty much all things – reflects assumptions about what kind of people are going to be using the things, and how those people are going to use them. That means that design isn’t neutral. Design is a picture of inequality, of systems of power and domination both subtle and not. Apple didn’t consider what people with eating disorders might be dealing with; that’s ableism. Apple didn’t consider what menstruating women might need to do with a health app; that’s sexism.
The fact that the app cannot be removed is a further problem. For all intents and purposes, updating to a new OS is almost mandatory for users of Apple devices, at least eventually. Apple already has a kind of control over a device that’s a bit worrying, blurring the line between owner and user and threatening to replace one with the other. The Health app is a glimpse of a kind of well-meaning but ultimately harmful paternalist approach to design: We know what you need, what you want; we know what’s best. We don’t need to give you control over this. We know what we’re doing.
This isn’t just about failure of the imagination. This is about social power. And it’s troubling.
Sarah is on Twitter – @dynamicsymmetry
Comments 19
Terry — September 30, 2014
Surprisingly, there is an open source menstrual calendar that respects your freedom and privacy.
https://arnowelzel.de/wp/en/projects/periodical
Perhaps it's time to stop granting these centralized authorities the power to make these decisions for us. Maybe we should support systems (free software) that enable more diversity in theory, even if they currently face superficial challenges.
I believe the agency of direct action that free software provides far exceeds any energy expended to counter systems and institutions that fundamentally deny that agency to its users.
Sumit — September 30, 2014
I'd like to make one clarification about the "chemical imbalance" you mention. There is no evidence for any chemical imbalance of people with OCD or Depression. None what so ever.
And I'd like to mention I do have moderate to severe OCD (when I was a kid I'd wash my hand several times an hour; lots of things I felt I couldn't touch, etc). I had several years of prescription drugs (which I didn't have a choice in; parents). I finally convinces my doctors and parents to let me off of them; hated the way they made me feel.
I voluntarily tried anti-depressants again in University, this time voluntarily, two different times which lasted several months, and I remembered why I hated them. They were even worse in University and built a higher dependence. In the end, therapy sessions with a good psychologist (there were so many terrible ones) helped more than any drugs. My own choices led my OCD from being severe to moderate/controllable (or at least hide-able).
There are studies that show different patterns in MRIs of those who are OCD and/or depressed, but only in certain circumstances. There is no measurable chemical deficiency of serotonin, dopamine or other neurotransmitters. Drugs like SSRIs alter your brain, but so does alcohol, caffeine and cocaine. They don't bring it back into a 'balance.' In fact most pharmacologists will even admit that they're not fully aware how most mental health drugs even work. They only show correlations with mood outcomes (and many of the studies that show SSRIs don't work long term or are no better than placebo, never make it through the peer review process. There is a known publishing bias).
But in any case, concerning your article, I think it's going a little overboard. The health app is just a tool. Could it be a dangerous tool for people with eating disorders? Possibly. Or it could also help them to not under/overeat (if they use the tool responsibly and don't lie to themselves).
The fact that you can't uninstall it goes to a much larger technological problem with so much of our commercial software and devices. I personally run Android with a 3rd party rom, but you shouldn't have to root/jailbreak a phone just to use a device that you purchased in the manner you want to use it. You wouldn't buy a car with the hood welded shut would you?
I feel that technologically, you should be able to uninstall a non-critical app and I do see this as a technology problem. But going as far as to say it's a health problem is a bit extreme and alarmist.
Erika Norris — October 1, 2014
As someone who has lived this - I physically beat myself while tracking my weight - I want to thank you for talking about the dangers of things like these.
I have a lot of friends who are into the Quantified Self and gathering as much data about their daily lives as they can. While, I think this is wonderful for them, I have learned the hard way that this is not something that I should partake in. That Apple won't give users the option to remove an app that is harmful to themselves is horrible.
Robin Barooah — October 2, 2014
Hi,
I think you are raising a very important issue: that the design of apps, particular relating to health and behavior, is a psycho-social issue, and decisions made by makers have a real effect on people's well-being. I very much appreciated your description of how many of the menstrual cycle apps are unpalatable because of the views reflected in the way they are styled.
However, I am a little concerned that you may be rushing to judgement when you go as far as claiming that the Health App is dangerous. I already see other commenters here starting to take this as a given.
As I understand it, the danger you are warning of is that the Health app will encourage unhealthy repetitive checking behavior in people with compulsive tendencies around weight.
My first question is can you be more specific about what the people you spoke to said would be triggering? Did you show them the app or have them try it?
The reason I ask this is that the health app is *not* designed as a way to help people *record* health data. It is primarily a way for people to control the flow of information between other apps that deal with health data. It *does* allow measurements to be added, but the purpose of this is really only to make amendments to the data, and process of doing this is highly impractical for using it as a tracker on its own. Try adding a weight data point, and see how many steps are involved.
That said, I see no reason that there should not be a setting to allow the app to be removed from the home screen.
On the second topic - of there not being support for recording menstrual cycles yet - I would point out that all of the other quantities that are recorded by HealthKit have generally accepted standards of measurement. Apple isn't currently positioning itself as a standards body for medical or health data - it is making technology to enable existing types of data to be exchanged.
Who should standardize the measurements for menstrual cycle recording? If there is already a widely accepted standard you can name that I have missed, I think you could make a more compelling argument along the lines of 'Why don't Apple support this well known standard that benefits women?'.
The alternative is that you are condemning Apple for not imposing their own standard, which seems to be in contradiction to the idea of listening to the actual needs of the people who will use the technology.
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