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Drowning in the River Parable: Our Favorite Public Health Story is a Noble Lie

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Most people know the story: Tom and Joe are fishing on a boat in the middle of the river, when they spot a baby floating past. Joe tosses his pole and jumps into the water to save the child, and Tom helps him back into the boat, checking on the infant. They’re rowing back to shore when they see two more babies floating downstream, so Joe jumps back into the water while Tom sprints away.

Joe grabs the children and then turns back to Tom, shouting, “Where are you going, you idiot? Help me with these kids!”

Tom shouts over his shoulder: “I’m going to find the maniac chucking babies into the river!”

You can get a laugh with the right delivery—”maniac chucking babies” has lots of hard /k/ sounds and that’s inherently funny. But the “going upstream” story isn’t really a joke. It’s an argument dressed as a parable, with contested premises and a tidy conclusion: we should address root causes, not just emergencies. The story circulates through public health conferences, activist trainings, policy workshops, and criminal justice seminars like a benediction: go upstream, find the source, put yourself out of a job.

These are my people, so of course I enjoy the story. But when you hear it often enough, you start to notice things. In most tellings, the story is about making non-heroic things feel more heroic. Joe saves the children—clearly heroic. But Tom’s heroism happens offscreen—we’re meant to imagine him wrestling some psycho to the ground and preventing future drownings. Both men are heroes, just different kinds. This equivalence matters to the advocates, policy wonks, and public health workers hearing the story, whose version of Tom’s upstream heroics involves writing grants, organizing campaigns, drafting legislation, or sitting through interminable meetings hoping for three minutes at the microphone to nudge policy incrementally forward. This work rarely feels heroic, but the story insists: Tom and Joe are both part of the solution, both heroes in their own ways.

That’s why the argumentative structure stands out. The parable only works because Joe manages to save every child. When Tom leaves, no one is drowning. Reality rarely offers such tidy arithmetic. The frontline need almost always exceeds capacity, making upstream work feel like abandonment. Imagine the story with children still rushing past, gasping and drowning, while Tom sprints away to search for causes. That’s closer to how these decisions actually feel.

The babies aren’t just metaphors: a former student of mine died recently. I did what downstream workers do: drove her to the police station—twice—to report abuse. Helped her find safe housing. Loaned money she couldn’t repay. Listened. Counseled. Hoped. My colleagues threw their own lines too, tried to pull her free of the river. None of it was enough. The tragedies kept finding her until the last one didn’t let go. So imagine the story again, but Joe stays in the water for more than a decade, and misses as many babies as he saves. Maybe that’s why we keep telling these “upstream/downstream” stories: because the alternative is admitting what actually happens to the babies.

My work now is definitely upstream work. It’s satisfying in its own way—not least because so much of it is writing work. The people with whom I collaborate are heroic, the challenges are interesting, and the details suit my nerdy bent.

But the river story assumes Tom knows exactly where to run. No five-year PhD program to identify which tributary harbors the villain. No chance Tom will devote his life to an upstream intervention that proves worthless or actively harmful. No unintended consequences exist in this world—though what would that even look like? Tom accidentally helping the villain find more victims? Maybe not quite—but it’s easy to imagine that Tom’s carefully brokered upstream solution may well require the babies’ mothers to attend workshops on “parenting skills.”

Upstream work is rife with unintended consequences. Well-meaning advocates for abstinence-only education promote a policy that the evidence suggests will worsen children’s sexual health, leading to more sex, earlier, that’s less safe. It’s painful to acknowledge—easier to assume malice than accept that good intentions can produce harm.

The seductive simplicity of the upstream story makes it perfect for any political perspective. Recast the river as the Rio Grande, make the fishermen Border Patrol, blame the cartels. Change it again: does rent control decrease housing supply? Do some NIMBYs cause gentrification while fighting it? The world forces tradeoffs, but we can ignore that when we’re sprinting upstream to address our chosen tragedy.

These examples will rankle readers across the political spectrum—but that’s beside the point. I want to focus on the issues raised by story structure itself. Whatever your ideology, the upstream story works because everyone can cast themselves as Tom or Joe, the smart one who sees the “root” problem, or the empathic one who refuses to ignore the needs of the real people suffering in front of them. Head, or heart? Either way you’re a hero.

Both Tom and Joe are trapped in impossible roles. Yet J.D. Salinger lampooned Joe’s trap decades ago in a book we all read in middle school:

“I keep picturing all these little kids playing some game in this big field of rye and all. Thousands of little kids, and nobody’s around—nobody big, I mean—except me. And I’m standing on the edge of some crazy cliff. What I have to do, I have to catch everybody if they start to go over the cliff—I mean if they’re running and they don’t look where they’re going I have to come out from somewhere and catch them.”

Holden Caulfield’s fantasy is pure Joe—an endless, impossible vigil at the cliff’s edge. On Salinger’s telling, it comes off a bit naive, an obsession with the pure victim, the complete innocence and authenticity of childhood that ignores all the complexity with which system-tinkering Toms are forced to wrangle. Unlike the river with its upstream perpetrator, the field of rye doesn’t need a catcher at all; it needs someone to fence off the cliff.

The story also erases race, gender, and class. In reality the large majority doing Tom’s job are white women, and the large majority doing Joe’s job are women of color, especially Black women. And the babies—the victims and clients? Almost always Black and brown, and always poor.

Go to any social services office, any emergency room, any homeless shelter. Who’s behind the desk doing intake? Who’s restraining the violent client? Who’s helping them navigate their housing options? Now go to any foundation, any policy institute, any legislative hearing. Who’s presenting the PowerPoints? Who’s writing the white papers? Who’s deciding which upstream interventions deserve funding?

The parable pretends Tom and Joe just happened to be fishing when babies floated by. Could it be that Joe’s neighborhood is downstream because Tom’s neighborhood votes to keep the toxic waste facilities, the highways, the flood zones somewhere else? You might worry that Tom is careful not to look too close to home.

The story’s most notable premise: victims are infants—completely innocent, completely helpless. They can’t drag Joe down with them. They can’t get angry when they notice Tom’s glitzy contracts from the lifeguards’ advocacy group, can’t accuse him of “coming to do good, but staying to do well.”

They also can’t help with their own rescue. Imagine adult victims: they’d join the rescue efforts, tell Tom where to look for causes, organize their own upstream interventions. But babies can only float and cry.

The story circulates at conferences because people patting themselves on the back for being Tom secretly wish they were Joe. Joe’s job seems simple—save the babies. Frontline workers get lip service and cheap talk about being heroes. But upstream folks have fancier titles, better pay, more control over resources. Meanwhile, the Joes are burning out, loaded with trauma and unpaid overtime.

The problem that the parable addresses is that the quotidian work of advocacy often feels inadequate. Every policy director wants to be Tom, finding and stopping the source of harms. Every social worker wants to be Joe, directly saving lives. This isn’t to say the upstream/downstream framework has been useless. Childhood lead poisoning rates plummeted because upstream advocates pushed for unleaded gasoline and paint regulations. Drunk driving deaths dropped when the focus shifted from rescuing crash victims to changing social norms and laws. Vaccine programs prevented millions from ever approaching the river’s edge. These victories matter.

But notice how these successes involve clear mechanisms: remove lead from paint, reduce poisoning. Mandate seatbelts, prevent ejections. The villain really was throwing babies in the river, and we really could stop him. The parable works when the problem is technical. It fails when the problem is poverty, racism, trauma—the compound fractures of injustice that don’t heal with a single intervention.

Usually there’s a proximate villain, an opposing coalition who stands between us and the root causes—but when they’ve been defeated the problems persist. Building slightly better guardrails, teaching swimming lessons, arguing about river regulations—it’s not exciting stuff. We’re doing work that’s incremental, frustrating, and impossible to capture in a satisfying story. It involves compromise and dirty hands. The big boss is always some concept or abstraction: Capitalism or Whiteness or Sin or Socialism.

Here’s what I worry: what if many of the world’s hardest problems don’t have maniacs at their source, just complex systems failing in predictable ways? What if the reforms we propose will improve but not abolish the situation? What if there’s no villain to wrestle, no single cliff to guard?

Heroic journeys promise a big save at the end. Would that it were so: mostly we just muddle forward.

Pragmatism, Pluralism, and Relativism

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Many people are fleeing social media, and my friend James Stanescu is trying to bring back blogging in response. He has an excellent post summarizing some of the differences between the pragmatisms of William James and C.S. Peirce. (I’ll call them “James” and “Scu” here for clarity.) Scu is drawing especially on Cheryl Misak’s capsule history, which itself is worth a read for reinvigorating the study of folks like Chauncey Wright and C.I. Lewis.

Peirce and James fought over the proper definition of pragmatism, as well as the term itself, but the simplest shared sense of the project is that truth and meaning are tied to use and inquiry. But Peirce emphasized inquiry, and James use, and that has made all the difference:

Peirce: “The opinion which is fated to be ultimately agreed to by all who investigate, is what we mean by the truth, and the object represented in this opinion is the real. That is the way I would explain reality.”

James: “The true is the name of whatever proves itself to be good in the way of belief, and good, too, for definite assignable reasons.”

I’m thoroughly with Peirce on this. But for Scu, ever the debater, this post is an occasion to also pick a fight with Peirceans on behalf of James:

Against Peirce’s metaphysical deflation, James gives us a metaphysical plenum. Pragmatism, for James, means living in a world that is disenchanted, re-enchanted, never disenchanted, never enchanted all at once. It means living in a world of scientific rationality and base materialism alongside the energies of God, all the Gods, things older than Gods, and beings that are yet-to-come. Horkheimer’s critique turns out to have some weight, James’ pragmatism makes the world both too subjective and too objective, both too rational and too mystical. 

My sense is that Peirce is not really a metaphysical deflationist like the logical positivists. For one thing he spins up a very complicated system of triadic relationships as categories or conceptual schema, and for another thing, he was some sort of pan-psychist. That said, he was at base a Monist (THE Monist) and so in some very, very specific sense he’s more a deflationist than, say, substance dualists. But not really like the logical positivists or scientistic materialists would be. Still, his monism is in stark contrast with the pluralism of William James.

To suck the nuance out of these debates, it helps to wonder: to what extent is pragmatism relativistic? I think neither James nor Peirce are truly relativists, and I find the Rortyan shrug as irritating as everyone else did. But Williams James was… an enthusiast. He sometimes let himself write and say things that smacked of relativism–more in line with his radical empiricism than his pragmatism, to be honest–and some of his adherents have taken this too far.

Scu was partly provoked into writing this up by Patricia Lockwood’s review essay on Simon Critchley’s mysticism book. It’s one of those wonderful takedowns that shows off the reviewer’s erudition at the expense of the author:

…as the inquiry wore on I began to experience a hysterical sympathy: there was such a rhythm of anxious restatement, so much of Critchley telling you what he was about to do and then not doing it, such endless throat-clearing and adjectival gooeyness and such a tendency for his mind to explode whenever he encountered a juxtaposition like ‘the ravishing far-near’.

It seems that it’s a philosopher’s job to say every word three times, its opposite twice and then the original word again, italicised. 

I loved the review, too, and so I guess she’s provoked us both. I’ve also spent more than a little time dabbling with mystic texts and traditions, and so I sometimes flirt with the academic study of the same–even though I can’t for the life of me find much value in it. There’s some kind of performative contradiction in studying such things.

Now, I think Scu’s post captures where I get off the bus with the Jamesean tradition–in both pragmatism and mystics. (While appreciating James’ psychology and his religious sociology all the more!) Ineffable spiritual traditions are fun to play around with, but the manifold claims of all the alternative practices that academics group together under that label can’t all be true! Most of them have to be false because they contradict each other, and I’m not impressed by efforts to embrace contradiction as some kind of deep logical wisdom. “Ah, yes, well after Gödel we must understand that contradiction exposes a deeper truth!” Sigh.

Here’s Scu again:

James’ system of verification and validation allows for a multiple ways of verifying something. If there are many processes that can arrive at different answers about if something is true, and there is no way to put these processes in some sort of hierarchy, we have utterly exploded the metaphysical possibilities of the world. We have therefore a multiverse, a pluriverse, a pluralistic universe (to use some of James’ terms). The world is, as James puts it, “ultra-Gothic.” 

The line I hate most here is “there is no way to put these processes in some sort of hierarchy,” such that–as he goes on to explain–aesthetic and scientific modes of determining truth are unable to correct each other but are instead equally true.

Whenever I sit with relativists, I find that two things seem to be true of their position:

  1. They really want to preserve space for pluralism, and so their relativism is a usually a species of liberal toleration with some metaphysical baggage they’re not really willing to embrace. Sometimes they’re also motivated by fear of error: a wise caution to which they grant an unwise metaphysical status.
  2. They don’t really care what this costs people for whom the principle of a fixed, shared reality is a hard–fought and oft-missed goal: victims of false confessions or lying witnesses, citizens of tyrannical regimes with flimsy propaganda, mentally-ill individuals trying to sort out their delusions and hallucinations from the truth, eager scientists seeking truth amidst fraud, etc.

I know it seems arrogant to say “actually, your heart is not being pierced by the nails from Christ’s cross, you’re just hallucinating real good,” but that’s my position! And in some sense Scu himself recognizes that this kind of relativism/pluralism of “no actually lots of contradictory things are true” runs into its own arrogance problems. His own work depends on the idea that the exclusion of alternative forms of experience leads to error and, in fact, to evil! For instance, there are true claims to be verified about animal cruelty that a thoroughgoing relativist would be tempted to ignore because so few people are really interested in them. But I maintain that genteel relativism is an attempt to one-up folks just trying to make sense of our shared world by saying that actually we don’t need to share it at all: everyone gets their own.

For the things that matter, like fascism or climate change, that’s not really true. It’d be nice if the folks who don’t believe in global warming weren’t polluting the same world as the folks who do, but the tragedy of existence–and its joy!–is that we must share one world. No one sane and good is ever a relativist or a (Jamesean) pragmatist about criminal guilt or innocence, about child abuse and the Satanic panic, or about vaccines. Relativism is always reserved for some other stuff that’s off to the side, like whether a particular artwork is beautiful.

(Scu cites Kandinsky’s aesthetics here, right on cue: K: “It is also exclusively from this inner standpoint that one must answer the question whether the work is good or bad.” Which Scu glosses: “Kandinsky’s truth is every bit as true as any logical inquiry.”) It strikes me that we built aesthetics precisely to get such truly relativistic judgments out of the way for science and ethics and ontology.

Now, I say that as someone who really loves pluralistic work. I also love fiction, even science-fiction and fantasy! I want to inhabit a political world where plural life-worlds and sources of meaning can flourish, where people are constantly inventing and imagining something other than the pure scientific truth.

I’m also more than happy to acknowledge that the technocratic liberal reality principle tends to its own abuses: in a world of deepfakes and misinformation, fact-checking can go too far. We can be overconfident and “correct” a true claim by reasserting an error, or a value as a fact. In that sense, I think that fallibilism is just as important as pluralism, and that fallibilism requires a reality principle to which we can return, reconsider, and correct ourselves or be corrected by others. A relativistic world is one with few reasons to change your mind!

That’s why I say that, practiced badly, Jamesean pagmatism tends towards a kind of solipsistic arrogance: if every relation with the world bears its own form of verification from which there is no hierarchy, corrective, or escape, then there’s no outside from which to hear criticism and reconsider, either. Deliberation, doubt, critical reflection, and reconsideration are all missing!

It’s worth noting, here, that Scu’s Jamesean pragmatism is in service of his radical/weird empiricism, and ultimately a challenge to anthropocentrism:

Radical empiricism affirms the realness of relations. 

Weird empiricism sees how these principles opens up a strange, bizarre, yes weird, pluriverse. One that can bring in the more than human world. Weird empiricism both sees the reality of our relationship to the more than human world (our relationship to other animals, but also ghosts, the sacred, imagined geographies, the dead and the undying). But also weird empiricism takes seriously the experience of the more than human world. That is, we can understand that other animals have a stake in claims of the truth because they can experience just as well as human. Though their truths may be alter than ours–weird truths from weird worlds.

And that idea, that animals have experiences that can act as a corrective to our epistemic and practical domination of them, strikes me as requiring fallibilism and ultimately undermining relativism. So I think what Scu says makes it clear that the terms of that pluralism can’t be metaphysical or ontological. I, too, want to enable as many compatible life-worlds as are mutually compatible! But there’s a ground truth out there that makes those shared horizons possible.