An Apple A Day Keeps The Doctor Away

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Most of Silicon Valley wants AI, flying cars, and to live forever. Does Apple want something different?

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Bedrooms are for two things.

Sleeping 7-8 hours a night, and reading seven minutes of a fantasy novel before I pass out.

Accomplishing both of these on a pretty frequent basis is the single most vital piece of my mental health.

A key way to make sure I accomplish them? By banning screens from the room. Specifically, phones. Specifically — in our homes, and probably yours — iPhones.

Which is ironic, because the company that makes them just announced they’re going to improve our collective mental health. Not just me. Not just you. Everybody.

And all it requires is checking in with your phone.

Some additional context: I’m extremely, historically privileged. Relatively to nearly everyone that’s ever lived I have an incredibly small number of things to be stressed, anxious, and/or depressed about.

I have a robust immune system and health care, I went to excellent public schools and college, I have worked for amazing people, my wife is wildly and deservedly successful AND an incredible partner and mom, I have seen and relied upon an excellent therapist for years, I have time to meditate, I am able to exercise — it’s absurd.

And yet I’m still up like clockwork at 2-ish AM most nights worrying about…everything?

Two weeks ago, Apple announced an integrated suite of improvements to their Health platform, coming in beta form this summer and for real this fall. Among those — a unified set of apps to help improve your mental health.

In particular:

• A journaling app

• A mood tracker

• A trend report, like the current ones in Health or Fitness you already ignore

• Standardized psychological questionnaires

To be clear, none of these things are new ideas. Apple very rarely introduces entirely new ideas or products, usually coming to the game fairly late and improving the user experience with vertically-integrated hardware and software.

Sometimes that means using unparalleled scale to crush the hopes and dreams of smaller companies that’ve been doing the thing for years now, or just buying those companies outright. Sometimes Apple’s version is less-good, sometimes it’s an upgrade, sometimes it’s not great and gets better along the way.

From Apple Maps to the Apple Watch to Apple TV to Pages to AirPods to password storage and Pages, Numbers, Keynote, and more, history is littered with Apple’s own take on a product, service, or category.

And now they’re coming for your mental health.

Should you be excited that the most powerful technology company that’s ever existed is trying to solve our mental health epidemic with an annual software update?

Should you be excited that an enormous company, whose C-Suite is 90% 65 year old white men, whose first attempt at Health tracking didn’t include menstruation, is trying to “solve” mental health? (god, do we have a long long history of ignoring women’s health)

The same company that made the magical device that played host to the social media platforms and tracking cookies that shredded our politics, our privacy, and the exact same mental health these past sixteen years?

The same company that later obliterated the tracking technology and business models of those same social media platforms, to protect your privacy, only to recreate the business for themselves?

The same company who designs nearly ever device I use to research, write, record, and run this business (and track my exercise, and stream my wife’s TV shows…)?

The same company that creates untold waste by releasing new versions of perfectly-fine products multiple times a year (but encouraging you to enroll in their trade-in upgrade program)?

The same company who sources their mythical, incredible, self-designed processors from the most contested island nation in the galaxy?

I don’t know.

But without going too far down the rabbit hole, I’m going to use this essay to try to work out my own feelings about it.

Because our mental health is in tatters, for a huge variety of reasons, and there’s very little evidence that our current setup — underbuilt, unaffordable, inaccessible, fractured, stigmatized -- is capable of turning the ship around.

Access to our most basic needs have become needlessly more complicated and our brains — like the porous limestone underpinning the entirety of Miami — were not meant to carry this load.

Let’s take a step back into 2019.

Just a few months before the pandemic really hit, Tim Cook, the most powerful CEO in the world, who’d most recently overseen the development, supply chains, release, marketing, and sales of a Watch that didn’t really have a market to even fit into, said, “Apple’s greatest contribution to mankind…will be about health.”

Fascinating.

I think Cook learned his lesson after trying and failing to make the Watch a luxury fashion item a few years before.

Cook, a gay man from Alabama, has made clear he is acutely aware of his place in the health landscape. In 2014 — five years before the quote above — and after years of rumors, Cook came out.

In an open letter, he described reading letter after letter “from kids who were struggling with their sexual orientation. They were depressed. Some said [they] had suicidal thoughts. Some had been banished by their own parents and family.

"It weighed on me in terms of what I could do….obviously I couldn't talk to each one individually that reached out, but you always know if you have people reaching out to you that there's many more that don't, that are just out there wondering whether they have a future or not, wondering whether life gets better … From there I really decided."”

While he once signed by wife’s paychecks, I clearly do not know the man. He may be among the wealthiest and most powerful people on the planet, but I think when Tim Cook — an avid athlete — says “health”, he doesn’t just mean padded bike shorts. At least, not anymore.

Before I type out the next paragraph, I want to make something clear — especially if you’re new here. I come from the Churchill school of “Give it to them straight, and then give them a reason to believe we can pull through.” Just in measurably less eloquent verse, and I don’t like baths.

Anyways (deep breath) — one pandemic, one devastated frontline health care workforce, 2-5 rounds of vaccines and boosters, 23-30 million estimated global excess deaths, at least that many nose swabs, tens of millions destabilized or disabled, most of them specifically targeted by Instagram ads for telehealth companies that didn’t exist a week ago, a couple terrifying elections and Supreme Court cases, a few hundred school shootings, a couple additional tenths of a degree in warming, 5-8 percentage points of inflation and a few years off our life expectancy, hundreds of book titles banned, some fires, flooding and basically no immigration later, our collective health is markedly less robust and our mental health is either a 18th century sailing ship hopelessly lost in the fog and/or a sack of feral cats hissing at each other between our ears.

But at least (some of us) are working from home more often!

Before we get into how and why they might make a contribution to mankind by way of health, I want to understand something:

Who among us might actually benefit from Apple’s well-considered software update?

Um, everyone?

Feeling sick or under the weather and not having paid leave for yourself or to take care of your children sucks. Sometimes it’s because of a pandemic, or the flu or menstruation, or literally whatever. No matter what, being sick in any capacity costs each of us our energy, and costs us money too.

All of us.

It’s astonishing in a country that worships quarterly growth above all else that we don’t pay people not to come to work when they’re sick, when and where they will inevitably get more people sick, and cost the economy enormous sums of money.

Sure, the work from home revolution helps quite a bit here, but most hourly workers simply cannot work from home. And it’s not surprising. This is the same country that continues to subsidize fossil fuel production, knowing it makes the air toxic, which makes people sick, and then they miss work or school.

It’s the same one that subsidizes fossil fuels, knowing it heats the oceans, which makes storms more frequent and more wet, which destroys communities, requiring billions in rebuilds, and people go broke and get sick and miss work.

Anyways! The Lancet, as reported by the Harvard Business School, claims depression and anxiety alone cost the global economy a cool trillion dollars a year.

I don’t necessarily think Apple’s new mental health tools will halve that or solve disaster relief, but anything helps.

Again — not a new idea. But the potential scale is what’s key here.

Young people

First off, young people buy (or are bought) iPhones. Why? Well, blue bubbles vs green bubbles. But that horrifying and artificial social division aside, let’s talk about the devastating effects of social media instead.

Bernie Sanders, the youngest old person on the planet, wrote an op-ed in The Guardian recently, detailing the state of young people.

From Bernie’s post:

• 40% of parents report being either extremely or very worried that their child is struggling with anxiety or depression

• Nearly one out of every three teenagers in America reported that the state of their mental health was poor.

• Two out of every five teenagers felt persistently sad or hopeless.

• Suicide is the second-leading cause of death among people age 15 to 24 in the United States

• Nearly 20% of high school students report serious thoughts of suicide and 9% have made an attempt to take their lives

• 32% of teen girls said that when they felt bad about their bodies, Instagram made them feel worse

• More than 40% of Instagram users who reported feeling “unattractive” said the feeling began on Instagram.

• About 25% of teenagers who reported feeling “not good enough” said it started on Instagram

Specifically, people of color and LGBTQ+ young people

COVID was overwhelmingly more dangerous and deadly to people of color. Marginalized people are more likely to live near fossil fuel facilities and on hot, red-lined city blocks, breathe wildfire smoke, and have dirty water.

This is no way to grow up.

“The social media companies ‘are directly responsible for the uptick in hate and violence on the LGBTQ community," GLAAD CEO Sarah Kate Ellis told Axios recently, pointing to more than 160 documented acts or threats of violence at LGBTQ events so far in 2023.”

Look. There’s pros and cons to every generation, from the Greatest Generation on down.

But a lot of the shit our kids are growing through is our — the adults — fault. We know young people can thrive with purpose, but then we fault or fail them when they find some and get up the nerve to post about it.

What the hell are we doing here?

Even if every single state passes a youth social media law, kids aren’t going to give up their phones (and neither are you). So we should absolute minimize how much we use them — especially around our families — by modeling good behavior.

My god. I wish I’d had that, then.

But some kids aren’t in school at all, as enrollment declines all across the country.

It’s easy to blame the pandemic for fewer kids in school, because it was a pandemic and we pulled them all out. But a quick calendar check shows the kids in high school, middle school, and most of elementary school were born before COVID.

Of course, that doesn’t mean some of those kids didn’t lose a caregiver in COVID or even earlier, because we have atrocious maternal health care — even for the former fastest woman in the world, a Black woman.

These kids might even be suffering because the GOP has made “no free lunch” a fucking political platform.

Are Cupertino-designed meditation bubbles going to make all that go away? No, they are not.

 Parents

Sure, we’ve got nice unemployment numbers, but there’s still no guaranteed paid leave or sick leave, and if you can find reputable preschool or childcare with insurance, you almost certainly can’t afford it.

Federal Democrats and Republicans alike abandoned the quickly-successful Child Tax Credit (even if some states have now picked it up), and so, yeah, it’s not too hard to wonder why fertility rates are in the can.

Also — it’s been almost a year since the Dobbs ruling, so. You do the math on that one.

Healthcare workers


Why am I calling out healthcare workers in particular? Have you been to a doctor or hospital recently? They’re shredded. Drastically understaffed, burnt the hell out, working for profit while their hospital’s in the red…and sometimes even held for ransom?

Anyways, you can sub in “teachers” or any other underpaid frontline profession here, but here’s a thing: doctors have been suffering from something called “moral injury” since way before COVID, a condition traditionally reserved for soldier’s who’ve seen or taken part in something that ”transgressed their core values.”

For a while now, that’s been doctors and nurses who’ve had to extract profit from every patient, no matter how sick, and now — when we’re already massively short on nurses, many of them are quitting.

Older people

Loneliness. The quiet pandemic.

As US Surgeon General Vivek Murphy wrote in The New York Times recently, “Loneliness — like depression, with which it can be associated — can chip away at your self-esteem and erode your sense of who you are.”

Throughout the world, as fertility rates fall and tens of millions in the Boomer generation barrel into their “Is it Alzheimer’s?” stage, more and more people are more alone than they’ve ever been.

Last month, Murphy’s office released a report on loneliness in America. From NPR:

But loneliness isn’t regulated to Boomers, as young people replace IRL interactions with online ones, trading more online relationships for poorer ones.

Anyways! Apple just built a futuristic computer that you strap to your retinas that will either be very good or very bad for this particular societal and psychological condition.

And maybe, just maybe, they’ll scroll Facebook a little bit less.

How we made it this far

Talk therapy began sometime in the 1800’s, and — if you can find the right person, and if you can afford it — it can work wonders.

It’s not for everyone, but I can attest that having someone you can say almost anything to with zero strings attached can be immensely helpful.

But — despite the best efforts of shady telehealth companies — it simply doesn’t scale. And decades of psychology studies have come under fire after attempts at replication failed down the line.

That doesn’t mean psychotherapy doesn’t work, it just means we need to be honest with ourselves that it doesn’t work for everyone, and we don’t know why or why not.

And listen: I don’t want to hear any of the “hard science vs soft science” bullshit. The same people who shit on psychology, anthropology, ethics, and philosophy on Twitter are the same ones who’ve spent the past fifteen years using behavioral science — all of those fields combined, basically — to get you to click on ads. Fuck them.

Marijuana — which is great — is still classified wrong and where it’s legal, the markets are mostly in shambles. Psychedelics research for PTSD and others has more supporters since MKUltra, but will some combination of a broken FDA and an ancient Congress bring it into the 21st century? I don’t know? (please donate to Run For Something).


Lastly, SSRI’s. Recent studies have controversially revealed more publicly what many professionals already believed: we aren’t sure if depression is caused by a chemical imbalance in the brain, which means we don’t know if SSRI’s really help with depression, and if they do, how.

I won’t go into all the other fucked up stuff we used to do to people with mental health conditions, but it’s safe to say, we need better data, and more data, and we need better tools to get it.

What the hell Apple is actually trying to do

Congratulations for making it this far. Let’s set some final context.

There are basically two competing phone operating systems on planet earth: blue bubbles (Apple’s iOS) and green bubbles (Android).

In 2021, there were at least three billion Android devices in the wild, many of which are outside the US. Forget about those for the rest of the article.

Meanwhile, Apple claimed this year that there are over two billion active Apple devices, and I think we can safely assume that iPhones are the majority of these, followed by Watches, iPads, and Macs.

My hypothesis is this: A very small percentage of an enormous number is a big fucking number.

How do we get there?

Well, every year, within six months of release, 70-90% of active iOS devices upgrade to the newest operating system.

So if we assume iOS 17 — with this new mental health toolkit — releases in September like usual, then by spring 2024, 70% of the active devices, or 1.4 billion devices will be on iOS 17.

Now, many of us have more than one Apple device, so let’s be ridiculously conservative and say half of that 1.4 billion is our working number of actual unique people with a device on iOS 17 by this fall. 700 million people.

Finally, let’s be brutally more conservative. If just 1% of those 700 million people use the new mental health tools, that’s 7 million people across the world suddenly enrolled in the largest mental health study of all-time.

(These numbers could be very different if even 2% use it, or on the other hand, if China bans the use of the Apple’s mental health tools because, well, whatever)

Anyways, even if literally nothing else comes from all of this data, even if we were tap-tap-swipe-swiping the iPhone equivalent of a cross-walk button that isn’t plugged into anything, research has shown that literally just reflecting on your own mental state can help build emotional awareness and maybe even resilience.

Now, you might say, “Ok but you just said a bunch of that reseach can’t be replicated” and I’d say “Bingo” but I’d also say “Does it make sense to you that paying better day to day attention to how you feel might help a little?”

Maybe!


So — can we get the bare minimum of 7 million people or more to do that every day? What about more?

Again, this isn’t all brand new. Apple’s Health app has been around for nine years, and the Apple Watch nearly that long. The Health app has got over 150 types of information it can collect (and in many cases, distribute to our doctors), including standardized physical and mental health questions that I’ve actually been answering for years.

Outside of Apple’s Health app, HealthKit provides other apps and services access to that data (should you give permission, and you should be very fucking careful about who you give that permission to), for connecting with electronic health records, for building clinical trials and more.

The part about clinical trials is actually very important. It’s so important I had a whole podcast conversation about it. Clinical trials are a mess. They’re wildly expensive and homogenous, among many other issues.

This is all to say: A bare minimum of 7 million Apple users (which, to be clear, are a specific demographic group unto themselves) suddenly reflecting on their individual mental health and building a collective treasure trove of data, could be a paradigm shift for the mental health field — and for all of us.

Can Apple “solve” mental health?

Of course not! But also, what the hell does that even mean? Will they try to squeeze every dollar out of it? Probably! The only other company in history this big and with these margins is an oil company. So.


Regardless — I’m glad they’re trying. Because is anything else working at scale? Not really?

I love technology, but I am extremely ambivalent about supporting Silicon Valley’s attempts or ability to “fix” anything, considering everything they’ve broken along the way.

But Apple — an incredibly imperfect nation-state — really isn’t just Silicon Valley anymore, and hasn’t been for a long time. The offices are still there (even if they’re empty!) and the foundation of SV is still there — it’s still mostly run by boomer white men.

But if climate change is the heat on our backs, the air we can’t breathe, and the water becoming harder to find, “Apple” is what’s in our pockets, our ears, on our wrists, and in front of our faces, every day.


Can all of this data, mashed together with your location and physical health indicators (vertical integration!), hopefully — jesus christ — as securely as possible, and yet standardized and anonymized enough for some not-evil algorithm to find some sort of signals and trends, unlock our ability to better assess who the hell is already suffering (hi), who might be dealing with heavy shit soon, and what are lowest common denominator treatments that help the most people?

And/or even, maybe, what works for you, specifically? Because you can just tap-tap-swipe-swipe tell it whether a suggested lifestyle modification actually helped?

….what if it can? And what if it can’t?

Good news: there’s a hell of a lot more we can do right now for ourselves, and for each other.

What we can do or: how to give a shit about each other

There is so much more we can each do right now, if we are able. We know what works.

Exercise

We know exercise — like walking, I fucking love walking — can help fight off dementia. It might halve the risk of developing clinical anxiety and make us more resilient. A single run or roller skating or who cares alters almost 10,000 molecules in our blood.

Relationships

The legendary 85+ year Harvard Study of Adult Development (popularized in The Good Life book (more on that soon)) incorporates every kind of reputable method you can imagine, including studies outside of their own.

But most importantly it’s their prospective, not retrospective work that is most effective — questions about right now. This type of data matters more and more over time and over increasingly numerous and diverse populations and circumstances.

And while their findings are extremely nuanced, one of the highest-signal benefits to a “good life” is strong, IRL, fulfilling relationships.

Apps

Like I said, Apple’s not the first to make this kind of software. I’ve been using the excellent Day One journal for a decade, and it’s fantastic. Similarly, many people swear by Rootd, the panic attack app, and millions meditate — or at least find some sort of connection and peace with themselves — with Headspace or Calm.

There are many others, but again I can’t be clear enough about this — be incredibly, ruthlessly discerning about who you give any of your data to.

And of course, understand that what works for other people may not work for you, or vice versa, or even really have any data behind it at all.

Organized action

There’s no way you were getting out of here without this part.

Improving the world around us — together — building on the work of everyone who came before it, through measurable actions big and small, compounded over time and populations can undo much — but not all — of what ails us.

We can choose to be hope.

For ourselves, and others. What does that mean?

Climate activist Emily Johnston said, “Our job is not to feel hope — that’s optional. Our job is to be hope, and to make space for the chance of a different future.”

For ourselves, and others.

But being hope takes diligent, present work. Project MIA founder Mariame Kaba said, “Hope is a discipline.”

We have to acknowledge what we’ve all gone through, that the coming years are going to be a rough, uncertain ride, and then buckle the fuck up.

After we take care of ourselves, we have to take care of each other, directly. What do I mean by directly? I’m talking about asking these questions every day:

How are you? How can I help? (Throw in an “I love you” just to keep things interesting.)

Being hope also means enough with the bullshit.

Future people in need have to be able to trust the tools available to them. Every time we sell them out, they’re going to trust us even less. We have to put the smack down on new and old health and telehealth companies and stop them from sharing and selling your data.

We have to get to real zero, we have to pass real gun laws, we have to tax the shit out of huge trucks, we have to stop wasting so much food, we have to clean our air and water, we have to dismantle and improve support systems for adults and especially kids, making it safer, more affordable, and providing mental health services in schools, just like we do nurses (sometimes).

We can recognize and rebuild our relationship with nature, paying for what we’ve destroyed, spending time among birds and in green spaces and building more for everyone who doesn’t have any.

There is nuance to everything, and lumping everyone’s mental health together would be an enormous mistake.

Acknowledging the immense scale of our problems and opportunities — from clean energy production to vaccines to hunger and heat — means breaking it down into the most hands-on examples possible. It’s what I try to do every day.

I am not so naïve as to think any one of us can cool the ocean back down, nor that any single technology company can “solve” any single problem, much less one from which they reap the bulk of their historic profits.

But I would also be very bad at my job if I ignored the scale of a technology already in the hands of a large fraction of the world’s population. Once, Apple used this power to magically shove a free U2 album into your music library.

This fall, they’ll try to do one better and help us all feel just a little bit less anxious.

— Quinn