Okay, so. Apple’s iOS8 Health app is an issue, at least potentially.

To recap, it’s an issue in significant part – and for the purposes of this – in terms of its effect on people who experience disordered eating and/or obsessive-compulsive behaviors and thoughts. Health trackers in general have the potential to do this, and in fact to be quite harmful. This is primarily because health trackers are highly quantitative in nature and extremely oriented toward the monitoring of details, and obsessive-compulsive tracking is one of the primary symptoms of an eating disorder – and the Health app is a focal point for this kind of monitoring. Though it allows for the entry of data, its primary purpose is to allow better curation of data from other health apps, but it still exists. In fact, it not only exists, but it can’t be removed. It can be hidden, but you – the user – still know it’s there. It will be difficult to ignore even if it can’t be seen. It gnaws. Trust me, things like that do.

It’s additionally an issue because these kinds of thoughts and behaviors aren’t something that people can just choose to stop doing. That’s why it’s a disorder, and it’s one of the most distressing things about this kind of disorder: if you’re presented with a relatively easy way to manifest symptoms, often you will even if you desperately don’t want to:

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.

Even if you don’t do anything, you’re still thinking about it. Over and over, obsessively. Thoughts are harmful, often physically. Thoughts themselves can trigger a relapse in someone in recovery from these kinds of disorders.

So now there’s the Apple watch, and some things have been added that are even more problematic.

Specifically, there are some shiny new apps. There’s a workout app, which naturally allows one to input goals and plans for physical exercise and track their progress, but the real kicker here is the activity app, which tracks almost every important aspect of the user’s regular physical activity through the day: the number of calories burned, the amount of time spent in motion, and a reminder to move when one has been stationary for a certain amount of time.

So what? So: the app is active all day. Or it possesses that capability. If we conceive of this kind of tracking as invasive for people with particular disorders – and remember that with these kinds of disorders something can be invasive simply by being there – then tracking that functions all day, tracking everything one does, is invasive to the nth degree.

It’s important to note here that it’s not only thoughts that matter in this context, for someone using this specific device. Concepts also matter. Even if someone else might not find the very prospect of this kind of app upsetting, someone who deals with the world this way might very well be upset by it. Upset is probably not a strong enough word. People are often skeptical about “triggers”, about people who are triggered by things – especially things generally seen as innocuous – but they’re real and they’re legitimate.

This is a health tracking app that’s locked into a device and is capable of constantly measuring just about meaningful everything you do, in terms of Apple’s standard of “health”. Yeah, that’s a problem.

Okay, just don’t buy an Apple Watch. But the problem there is that – as with the original Health app – Apple wasn’t thinking about this. The idea that someone might want to buy an Apple Watch but feel unable to do so because of disordered thoughts and behaviors simply wasn’t on the designers’ radar. They made these apps for a generalized default person with a generalized default attitude toward a generalized default idea of what”health” means. At the very least, design that essentially erases an entire category of potential users is probably worth some consideration. As Selena Larson points out in the Kernel article linked above:

Fitness apps and health trackers aren’t inherently bad or good. They’re tools that can used in different ways and come with their own built-in blind spots and biases. Apple’s decision to force Health onto iOS 8 devices could endanger those who have a compulsion to track themselves already. But for the great majority of people, monitoring their health should pose no harm.

Apple sees the world a certain way and designs their products accordingly. No, I’m not faulting them for that. But I do want to call attention to it, because – like all ableist design – it stands out as part of a much larger set of cultural and social marginalizing processes. Apple’s focus is on the “majority”. We need to ask whether that’s all we should expect, or whether better and more accessible might be possible, and what greater effects that better design might have.

But there’s another interesting question here, and it’s the degree to which an Apple Watch truly differs from an iPhone, in terms of how one might use it. Tom Greene argues:

For the Apple Watch to take off, it will need to carve out a distinct value proposition that a smartphone alone cannot deliver. After all, we all pretty much “wear” our smartphones everywhere we go. The combination of Apple’s iPhone 6 technology, coupled with my Withings products seem to make the health-related aspects of Apple Watch unnecessary.

What’s the difference, in practical design terms, between a watch on your wrist and something you carry around? This raises even bigger questions about physical relationships with physical devices, in terms of proximity and how – in an embodied sense – we experience what are essentially cases for apps.

What’s the difference between a watch case and a smartphone case? Does the packaging itself matter? How?

I think these are questions for another post. But I wanted to leave them here, because I don’t think we can consider the design of an app without – at least to some degree – considering the physical thing the app rides around in.

Sarah is on Twitter – @dynamicsymmetry