Title: Unnatural Causes

Author: Richard Shepherd

Type: Non-fiction

Published: 2018

Pages: 422

For fans of: This is Going to Hurt, My Life in your hands & Being Mortal

When I picked “Unnatural Causes” for my summer read, I thought I knew what I was getting myself into. Having read several doctor-authored novels from emotional stories of front-line doctors like Dr Clarke’s “Your Life in My Hands” to the comedy-infused diary entries of Adam Kay in “This is Going to Hurt”, I assumed Shepherd’s work would tread a similar path. But that was far from the truth. “Unnatural Causes” is a fascinating dive into forensic pathology, the changing landscape of British medicine and the life of the man who bore witness to it all: Dr Richard Shepherd. 

The Plot

“ ’Tis not enough, Taste, Judgement, Learning, join; 

In all you speak, let Truth and Candour shine: 

That not alone what to your Sense is due, 

All may allow; but seek your Friendship too. 

Alexander Pope, An Essay on Criticism”

Unnatural Causes begins with the immortal words of Alexander Pope, setting the perfect tone for Dr Richard Shepherd’s brilliant memoir. Pope’s emphasis on honesty, honour, humility, and decency serves as a motif throughout the book, forming the ethical and moral backbone that underpins many of Shepherd’s decisions. Structurally, the book seamlessly transitions between Shepherd’s life as a forensic pathologist dissecting the deceased in the post-mortem room, the hallowed halls of the Old Bailey courtrooms, and the cosy comforts of his role as a father and husband, offering a vivid representation of the fast-paced reality that defines Britain’s most renowned forensic pathologist.

Unnatural Causes is not merely a clinical exploration of death; rather, it opens doors that would otherwise remain locked, explores wounds that beg examination, and reveals the stories of lives that met an untimely end. Through Shepherd’s deeply personal journey, we gain a deep understanding of the profound impact that such meticulous intimacy with death and its haunting hallmarks have on the human mind. Shepherd’s commitment to candidness, a testament to Pope’s teachings, shines through in his unflinching reflections on his marriage and his battle with PTSD.

Catapulted to prominence through his pivotal role in the investigation of “The Hungerford Massacre,” Shepherd guides readers through similarly harrowing and widely publicised cases, such as the 9/11 attack and the untimely death of Princess Diana. Viewing mortality through Shepherd’s keen eyes is a unique and profoundly captivating experience all stemming from his unwavering passion for the intricacies of medicine. 


“Reconstruction is important. It matters a lot to anyone involved, and it matters to the wider world. As humans, we have a need to know. About specific deaths. About death in general.”

Unnatural causes was a timely awakening about the intricate beauty of pathology. Gone were my preconceived notions that pathology was a speciality removed from human contact, banished to the dark depths of hospitals for fear of the spectre of death spreading to other patients. Like a fog light, Shepherd clears the mists surrounding the procedure of post-mortems and explains in detail why pathologists do what they do. 

The care and passion with which Shepherd speaks about each post-mortem and each dissection of the human body reveal just how much of an art this line of work is. With each cut, Shepherd is reaching past the precious physicality of the human body to arrive at the ephemeral, glimmering truth. It was heart-warming to see how much each patient that arrived cold and lifeless to his hands was not callously mutilated but investigated with utmost respect and care, to bring peace and closure to not only the family but the individual themself.

Like any doctor, pathologists deal in the world of bringing forth the patient’s story. The only difference lay in the fact that death has rendered the testimony of the deceased mute. Unable to coax out words, the pathologist instead examines the body in minute detail, painstakingly interviewing every limb, tissue and cell for phrases that might speak through the veil of death. Shepherd puts it best when he says:

“So, without uttering a word, the body we’re examining today will be our witness and our teacher.”

Besides extolling the beauty of pathology being one of the most unique and intimate specialities of medicine, Shepherd shares his ongoing efforts to improve communication with police officers who witness post-mortems. He nobly endeavours to ensure that those who, unlike medical students, doctors, and healthcare staff alike, have not dedicated their lives to witnessing death, do not leave the mortuary feeling traumatised. 

Additionally, the reader is held privy to a rather morbid yet fascinating foray into the Shepherd’s particular speciality: homicides by knife. We are afforded an eerie insight into the inner workings of Shepherd’s mind as he astoundingly sketches out possible murder weapons based merely on the journey of the weapon through the body and depicts vivid reconstructions of the events surrounding the homicide, in a manner that can only be said to mirror the impossible abilities of Sherlock Holmes.

On a grander scale, Shepherd also offers insight into the winds of change sweeping through British forensic pathology. The usual culprits of funding and legislation slowly but surely closed the forensic pathology departments and forced them into the privatised world. No longer funded by the universities where they were once integrated, the loss of accessibility to forensic pathology as part of the medical school curriculum is a tragic development that I mourn with Shepherd and one Unnatural Causes perhaps could have delved more into.

Mental Health

“Everything I thought I had known or cared about suddenly had no meaning. Much of the day I simply concentrated on trying not to blink, since I had noticed the images that hovered over me, waiting to kidnap my mind, were quick to pounce when I closed my eyes.”

Of course, no memoir would be complete without a discussion of life’s challenges. With the level of tragedy and depths of human brutality that Shepherd has witnessed it is perhaps not surprising that he battles with PTSD and depression. A career in pathology offers a closeness to death that is probably unparalleled in medicine, but I wonder at what cost. As with every aspect of this book, Shepherd’s mental health is explored sensitively and written tenderly. 

The human mind is exceptional in its ability to conjure up tapestries of torture from the depths of our subconscious, and in Dr Shepherd’s case, there was fuel enough for a lifetime of nightmares. 

Realistic, raw, and tender Shepherd’s reflections on his mental health are only explored in the final chapters of the book but are no less impactful. The section when Shepherd’s PTSD momentarily lifts for an afternoon is among the most precious and poignant of the book. Shepherd bleeds colour back into his world and although being cured from such a condition is never absolute, it was heart-warming to see him gaze upon the beauty of the world with almost childlike wonder and regain the will to remain this side of mortality. 

Throughout “Unnatural Causes”, Shepherd’s ability to peel back the layers of his own psyche and candidly share his vulnerabilities adds an undeniable authenticity to his storytelling. His willingness to confront the darkest corners of the human experience – both in his professional work and personal struggles – makes his memoir a compelling and deeply human memoir. 


“The heart is an organ one can hold neatly in the palm of one’s hand. So small but so steady, a little fist, clenching and unclenching seventy times a minute, day and night, year after year, 30 billion times over a lifespan. A faithful friend. Until it stops.”

A memoir of a husband and father, a love letter of a doctor to his speciality and a record of witness to the lives of his patients. In Unnatural Causes, Dr Richard Shepherd masterfully intertwines the quotidian and the inexplicable with an unyielding commitment to the truth, offering readers a remarkable exploration of life, death, and the human resilience required to understand everything in between. It is a book that stands alone within the doctor-authored medical genre, depicting stories and experiences that linger long after the final page is turned.