Dr Sessa is to be congratulated on his welcome review of research into psychedelic drugs. We are reminded of the hope that these drugs ‘could be for psychiatry what the microscope is for biology or the telescope is to astronomy: an essential tool to explore the parts of the internal world that are usually inaccessible’.

Grof (Reference Grof1975, Reference Grof1990) has been the most prominent explorer of these inaccessible regions for over 40 years and once research into lysergic acid diethylamide (LSD) became impossible, developed a technique for inducing non-ordinary states of consciousness called ‘holotropic breathwork’. This offers many of the features of the psychedelic state without the need to take a drug. Using insights from the use of LSD and holotropic breathwork in thousands of people, Grof (Reference Grof1975) proposed an extended model of the psyche with psychodynamic, perinatal and transpersonal layers. These are provocative models of mind which challenge existing Western paradigms of consciousness and which probably reinforce mainstream suspicion of any insights purporting to arise from the psychedelic experience. However, they do represent a serious attempt to explore, describe and understand the complex features of the non-ordinary state of consciousness and its theoretical implications.

Holotropic breathwork is marketed more as a means of personal exploration than psychotherapy, but careful preparation, the context, a highly supportive setting and integration after the non-ordinary state of consciousness are deemed crucial if the experience is to have value (Reference GrofGrof, 1990). This approach is in contrast to the views of Strassman (http://www.tripzine.com/interviews.asp?id=strassman) who researched the use of N,N-dimethyltryptamine (DMT) in 65 volunteers between 1990 and 1995 in a hospital setting with little attention to the surroundings. Strassman (Reference Strassman2000) concluded that DMT probably did not have a beneficial effect in itself, that its use was high risk and that psychiatrists generally did not have the experience, sensitivity or training to support, contain, direct or interpret the more unusual experiences that arise. Thus, although the drug is easily taken, the context and setting is a little more complicated and is at least as important.

My point is that psychedelic drugs are just one of a number of methods for the induction of a non-ordinary state of consciousness. Non-drug methods for the induction, exploration of and therapeutic uses for non-ordinary states of consciousness may prove to be more productive for psychiatrists interested in this area, given the controversy that the use of psychedelic drugs will always arouse.