Unnatural Causes

Recommendation: Yes – well worth while

Read with: Gin and tonic, of course, old boy

Where to read: Curled up on the couch

In brief: Unnatural Causes hooks right into the current trend of true crime and the ever-popular police procedural and leverages it to impart some actual knowledge, along with a hefty dose of human decency. It is also a wonderful read. Anyone interested in the criminal law (or who liked Bones) should give this a read.


I should say from the outset – if you are after voyeuristic details about prominent murders you will be disappointed I think. There’s awful material and awful crimes contained in these pages, sure, but Shepherd’s handling of each case is dignified and sensitive. You should read it so I shan’t go into too much detail about the cases he talks about, but I do want to note a couple of themes which emerge across the book.

Death: this may seem obvious but I think it is worth noting that we don’t talk about death enough. I don’t mean murder and destruction and sickness here, because violent or “untimely” death gets a lot of attention, but rather the natural process of dying, of dying as an inevitable process. I enjoy Dylan Thomas as much as the next man, but I’m not sure raging against the dying of the light is always the correct approach. The book is a refreshing acknowledgement that while many deaths are indeed a tragedy, death is a very human, inevitable fact of life.

Diagnostic trends: it’s disturbing to think of causes of death or illness as trend-driven (it’s disturbing enough to know that ruffles are back in fashion) but Shepherd touches on “fad” diagnoses or bad science and the outsized impact they can have when amplified by the media (“recovered memories“, for example).

He looks at SIDS in particular, from its increasing prominence in the 1970s and 1980s to the ‘Back to Sleep’ campaign and the increasingly cautious approach to SIDS diagnoses in the medical profession and pathology. From the 1990s onward, researchers began to suggest that child abuse was more common than previous thought and ‘shaken baby syndrome’ caught on in the popular imagination. Accordingly, pathologists became less likely to record an infant death as SIDS and more likely to suspect foul play. Unsurprisingly, this is still highly contentious.

SIDS rates (deaths per 1,000 live births) in the UK from 1979-92
SIDS rates (deaths per 1,000 live births) in the UK from 1993-2014.

PTSD: strangely, because Shepherd takes a very broad brush approach to his personal life, his story is bookended by his experience of PTSD and coping with the trauma and vicarious trauma of the job. It’s not hard to imagine how it could happen, indeed how could it not, when your work encompasses mass disasters, murders and the aftermath of 9/11 and the Bali bombings. It is genuinely moving to see a senior medical professional writing about mental illness and distress, particularly as a member of another profession (law) notoriously bad for mental health and even worse at handling it.

Other notable themes explored through the book include the effective prioritisation of pathology as universities stopped supporting it and stopped training graduates and the conflicts between the legal system (and the legal profession) and the medical practitioners called to give evidence in it.

In sum, this is excellent, thought provoking and far more worth the weekend it’ll take to read it than the four rather grotty Netflix documentaries I could have watched instead.

On a side note, if you’re interested, there’s some interesting research about end of life care from Western Sydney University here (or just read up on death doulas).

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