Book Review: August 2019


Unnatural Causes


Dr Richard Shepherd

Dr Richard Shepherd is a forensic pathologist and this is a professional and personal memoir of his forty plus years in that business.  It’s easy to see why it has attracted such good reviews. It’s a fascinating subject to read about and, at times, a rather difficult one.  Quite a lot of it is devoted to his work in the aftermath of mass disasters, especially the Clapham train crash and the sinking of the Marchioness – so it is of direct interest to emergency management practitioners.  But it’s also a compelling and brutally honest account of one man’s long-term and gradual descent into PTSD – and how he managed it.  Finally, it’s extremely well written.  When it comes to describing some appallingly distressing events he does so with a level of dignity and respect that never slips and is never prurient.

The book opens with what Dr Shepherd saw as a rite-of-passage: the first major investigation he led on.  This was the Hungerford massacre.  He uses the experience to expose what will become a recurring theme, which is the separation of work and home lives and the transition between them.  He keeps returning to the theme of “detachment”, how to maintain it (by not talking about it) and how that coping mechanism eventually unravels.  That’s the first dimension of the book that I found really gripping.  The second is his focus on the bereaved and his obvious compassion for them.  This is all the more interesting because it’s shot through with a commitment to the truth – helping people in their grief by finding out how their loved ones came to die.

The author’s first exposure to a big disaster was the Clapham train crash, in which 35 people died.  The first responsibility was to identify the victims.  This must always be done with absolute, rock-solid certainty because misidentification is unthinkable.  That takes time. But it can never be done quickly enough for the families of the victims or, indeed, for public curiosity.  This creates tensions in situations with mass fatalities and usually leads to criticism of the authorities.  To show some of the difficulties, and prove the need for absolute certainty, Dr Shepherd points out that four passengers on the smashed train had exactly the same names, two of them were in the same carriage and one of them was dead.

The difficulties of accurate identification were compounded after the Marchioness disaster, because the victims had been immersed in water. With hindsight, we can see that various things were wrong with the processes behind identifying the dead and in dealing with the families. To some extent it seems as if social expectations had moved on but pathology hadn’t.   For example, if a body has been immersed for a while conventional fingerprinting won’t work.  At that time, it had to be done in a specialised laboratory which couldn’t handle whole bodies.  So, the hands were removed.  News of this (then completely standard) practice was very distressing to the families. 

Dr Shepherd bore the brunt of this outrage and was unfairly criticised in the media.  He never tried to use the “it’s the standard practice” defence, but he didn’t order the removal of the hands either.  He spends quite a lot of Chapter 27 discussing the changing relationship between truth, the “purity of science”, attitudes and beliefs – making the inevitable conclusion that the boundaries between them tend to get blurred.  Also, some of his experiences of the justice system bear out its essentially adversarial nature; ad hominem attacks on the reliability of the forensic pathologist as an expert witness seem to have been common feature of the process.

I’ll finish with a quote from Dr Shepherd;

My PTSD is not caused by any one of the 23,000 bodies on which I have performed post-mortems.  And it is not caused by all of them.  It is not caused by any particular disaster I have been involved in clearing up.  And it is not caused by all of them.  It is caused, in its entirety, by a lifetime of bearing first-hand witness to, on behalf of everyone – courts, relatives, public, society – man’s inhumanity to man.

His treatment:  a long holiday, pharmaceuticals, talking and writing this very good book.

Reviewed by Mark Leigh