(Originally published as a newsletter for The Dragontree Holistic Day Spa)

In the late 1950s, a psychologist named Lawrence Kohlberg proposed six levels of human reasoning, a theory now known as Kohlberg’s Stages of Moral Development. In a nutshell, Kohlberg explained that these six stages can be grouped into three main levels (with two stages in each level): pre-conventional thinking, conventional thinking, and post-conventional thinking.

In pre-conventional thinking, found mostly in children, we make decisions from a self-centered perspective. Right and wrong are determined by whether we stand to be punished or to gain from our actions. The needs of others are seen as secondary to our own needs. This is called  pre-conventional because we have not yet taken on the conventions of society.

Conventional thinking is marked by an adherence to the rules and standards of our community. We adopt these standards through a desire to conform or to be approved of by our peer group. In the second stage of this level, our adherence to convention is based on a belief in the rightness of the laws and customs of our community. We see laws as being in place for the common good. Here, individual needs come secondary to community needs.

In post-conventional (or trans-conventional) thinking, we see that our community is made of many individuals, each with their own needs and beliefs. Sometimes these values are different  than society’s values, but this doesn’t make them wrong or invalid. We see that laws are social contracts that can be changed. In the final stage, our reasoning is based on universal ethical principles that transcend laws; laws that are unjust may need to be broken.

Kohlberg believed that we move through these stages consecutively; it’s not possible to skip a stage. Many people spend their lives in the pre-conventional level, never adopting conventional reasoning. Most people don’t make it to the post/trans-conventional level. But, interestingly, it appears that a significant number of people at the pre-conventional level believe they are practicing post-conventional reasoning.

It’s easy to see how this might occur, since both pre-conventional and post-conventional thinkers are non-conventional thinkers. The pre-conventional thinker encounters the post-conventional thinker and says, “You’re not into the status quo and neither am I – we’re on the same page.” This has been called the “Pre/Trans Fallacy.” While both people may address themselves to the needs of the individual over that of society, the pre-conventional thinker is actually (maybe secretly) motivated by the needs of one particular individual – himself. The post-conventional thinker, on the other hand, is devoted to all  individuals.

Ken Wilber writes about this in his fantastic book Grace and Grit. Vietnam War protestors in Berkeley were interviewed to determine what level of reasoning they were using to justify their opposition to the war. While nearly all of them believed their opposition was for high-minded principles, when they were really pinned down, it turned out most were pre-conventional thinkers. The main reason they were against being drafted is because they didn’t want anyone telling them what to do.

While Kohlberg’s theory specifically addresses moral development, I feel this model is applicable in many other arenas. One of my main inspirations is personal evolution and helping to facilitate others’ evolution. Kohlberg’s model can be a useful tool for examining our beliefs and seeing where we may be able to grow.

To use Kohlberg’s terminology loosely, I believe our initial attitude toward anything in life is oriented around what’s in it for us. (“Should I go into medicine? Hmmm… what would I get out of it?”)  We try to figure out if it will benefit us or help us avoid discomfort. This is essentially pre-conventional thinking. We may be reluctant to accept the status quo and its rules because of a perception that our own needs will become secondary to those of the group. We can no longer exploit the system if we play by the rules. Also, our initial relationship with a thing is directed by our own free interpretations (like a self-taught piano player). Another reason we may be reluctant to adopt the mainstream view (e.g., taking piano lessons), is that we feel that by conforming we’ll lose our individuality.

In the conventional stage, we recognize the value of the mainstream view. We learn how to get things done in the world, to use the system in a healthy, non-exploitative way. We see that by learning how to play piano in the traditional way, we may benefit from the techniques and notations of others. We play by the rules and the system works for us.

Except when it doesn’t. Finally, without rejecting the experience we gathered through adopting conventionalism, we may choose to go beyond it, just as a classically-educated pianist may one day transcend her training. This is post-conventional thinking.

The successes of the alternative health community are due in large part to the efforts of post-conventional thinkers.  But alternative medicine tends to be very attractive to pre-conventional thinkers too.  When I was first discovering alternative medicine, it was exciting to me partly because I had a rebellious streak.  I encountered many folks who liked alternative medicine not just because of its merits, but because it wasn’t conventional medicine.  I would hear someone zealously listing the benefits of their raw food diet, but seething beneath was an attitude of “the mainstream can’t tell me what to eat.”  I also visited many stores and websites run by people who seemed to believe that all unconventional viewpoints on health – from voodoo to pyramids to chiropractic – are equally valid and belong in the same place, simply because they’re all unconventional.

My peer group was highly politicized. While our main interest was to help people, an attitude of “us versus the mainstream” infiltrated and diluted our communications. Dietary recommendations might be offered with an aside of, “You should eat this way because the food manufacturers are all in cahoots to feed us a bunch of garbage, and it’s a big conspiracy pushed by the FDA and the AMA and the food boards. They’re all keeping it hidden that the food we eat is terrible for us. And the reason you should use alternative medicine is not mainly because it’s useful but because mainstream medicine is bad and corrupt and ruled by drug companies, and it kills so many of its patients.” You don’t have to look deep to see the pre-conventional thinking here.

Over the years, I have worked to let this agenda go.  I have noticed that the more open I allow myself to be, the less black and white the world becomes, and the more moderate I get.  I have patients who really want to focus on how bad the mainstream is, expecting me as an acupuncturist to surely corroborate their story about the evils of conventional medicine and nutrition.  But I feel less and less like joining in.  This isn’t to say I don’t want to hear a person’s story; but it’s just not purposeful to focus on what didn’t work for them.

The truth is, there are many aspects of modern nutrition and food production that are a sad departure from the way humans have done it in the past.  Most food manufacturers do not have nutrition on their agenda.  Most peanut butter is actually corn syrup and margarine with some peanuts added for flavor.  The AMA and FDA have taken obvious efforts to suppress the growth of alternative medicine.  And my aunt, who might have passed away naturally from her terminal lung cancer, died instead from the overuse of toxic chemotherapy drugs and a negligent hospital staff.  So, yes, mainstream medicine does its share of damage, and so does mainstream nutrition.

But if we are to be truly holistic in our treatment of human health, we can’t throw the baby out with the bath water.  A post-conventional thinker has to first accept convention.  The mainstream has its merits.  It doesn’t make sense to dismiss drug therapy simply because it doesn’t come from herbs.  Sometimes a drug or surgery is the best choice.  But at the same time, we should not make the mistake of believing that the sheer number of people who believe in it somehow validates the conventional approach.  By the same token, the fact that mainstream medicine has its drawbacks does not bestow legitimacy on all that is alternative.

A recent article by conventional thinker Steve Salerno in the Wall Street Journal, “The Touch That Doesn’t Heal,” claimed that despite the fact that Americans spend more and more on complementary health care, the reality is, it’s worthless.  Like the narrow-minded alternative types who put pewter figurines of dragons on the same playing field as massage, Salerno lumped all non-mainstream therapies together: acupuncture, DNA activation, therapeutic touch, and others.  He insisted that none of it is proven, and that the scant research that exists invariably finds it ineffective.  As I see it, his message is, Americans are a bunch of dupes, just waiting to be swindled by the next snake oil salesman.  You don’t know what’s good for you.  You may think you’ve benefited from this stuff, but you’re wrong.

Let’s not be like Steve.  We don’t need  to accept or reject the mainstream just because it’s the mainstream, nor to spurn or embrace the alternative just because it’s the alternative.  I believe the next health revolution will be defined not by “mainstream” or “alternative,” but by informed consumers who can think for themselves, read labels, and come to their own conclusions.


Copyright 2009 by Peter Borten. No unauthorized reproduction in any form without permission.