Readers will recognise the mythical force of a forgotten warrior hero returning from obscurity to achieve deliverance from a villainous tyrant. Saving Normal is marketed along these lines. Allen Frances, Chair of the DSM-IV Task Force, described on the flyleaf as once the most powerful man in psychiatry, has emerged reluctantly from retirement to do battle with the evil excesses of DSM-5. This has fallen into the wrong hands (a coalition between the American Psychiatric Association and extreme commercialism) and has gone bad. Powerful forces are trying to convince us that we are all sick, thus robbing humanity of its essential normality. Not to mention making billions of dollars on the way.

Frances writes well, and is no stranger to hyperbole. Profits are reaped not earned. Psychiatric medications are star earners for drug companies. Researchers have inserted pet diagnoses, which are rampantly hyperinflated. DSM-5 has become an obese monster, and a publishing profit centre for the APA. Such rhetoric can border on paranoia, but Frances believes that psychiatric overdiagnosis is an exemplar of the bloat and waste that follows throughout US medicine when commercial interests hijack the medical enterprise.

After such a rousing analysis, and a thought-provoking outline of diagnostic fads, past, present and future, Frances then reveals his practical road-map back to a sane and safe psychiatry. Big Pharma, identified as one of the main adversaries, is to be tamed. No more free lunches, no more off-label marketing, no more beautiful salespeople congregating in doctors’ waiting rooms, no more co-opting of ‘thought leaders’. More contentiously he also seeks an end to campaigns for disease awareness. To counter the excesses of DSM-5, Frances advocates careful stepped diagnosis, moving from attempts to normalise, through watchful waiting and minimal interventions, towards brief counselling, and finally definitive diagnosis and treatment. While acknowledged as innovation in the USA, much of this is familiar ground to UK practitioners.

For many readers of this Journal, struggling to keep a grip on a National Health Service they feel slipping away from their grasp, Saving Normal will appear as a dreadful transatlantic warning of the shape of things which might come. In this context, the rhetorical shock and awe, and the lack of balanced argument, will diminish its impact. In so far as the book is targeted at a lay readership, it should be better judged by the standards of popular journalism, although in that arena too it has already been criticised for its lack of objectivity.