Editor:

We appreciate Dr. Wettstein's thoughtful reading and commentary¹ on our paper “POWs Versus Torturers: Forensic Evaluation of Military Personnel,”² and would like to share some of our responses to his critiques, particularly regarding our methods in evaluating the group of 17 plaintiffs suing the Republic of Iraq. Dr. Wettstein rightfully highlights the potential flaw in the evaluations performed largely by telephone contact with the POWs and their families. An ideal scheme would have involved recruiting separate experts nationwide to perform individual evaluations of the plaintiffs. We would be interested in learning if this approach has ever been undertaken in a tort involving multiple plaintiffs.

As we point out in our paper (Ref. 2, p 318), such a scheme was neither feasible nor realistic, given the logistic realities and time limitations in this matter. Although Dr. Wettstein suggests that we should have declined to conduct these evaluations given the limitations, we argue that our findings and opinions are valid.

Dr. Wettstein specifically questions the accuracy of our assessments, given the use of telephonic interviews that averaged approximately 1.5 hours with the POWs and 1.2 hours with their family members (mostly spouses). We should have noted in the paper that the length of these interviews was dictated by the material covered and that no artificial time limits were imposed. Further, plaintiffs’ responses, coupled with the extensive documentation, touched on all the areas noted by Dr. Wettstein as relevant to the forensic evaluation of trauma (Ref. 2, p 330). Each of these areas was, in fact, covered in our reports for each individual.

We continue to maintain that, in light of the extensive documentation of our interviews, we were able to perform valid evaluations and formulate reliable opinions, which we then couched in more conservative language in deference to possible objections regarding our telephone interviews. Further, as we noted, our findings were consistent with the literature in course and frequency of symptoms. This congruence served as a check on possible bias and what Dr. Wettstein refers to as the “risk of being overfocused” (Ref. 2, p 330). In our own forensic experience we have observed that experts rarely compare their findings with the literature. This deficit was highlighted in a presentation at the most recent American Academy of Psychiatry and the Law (AAPL) meeting regarding prognostication in cases involving PTSD.³ A more systematic study of how the literature is utilized in forensic reports would be a useful contribution.

Dr. Wettstein also suggests that experts familiar with military trauma may have had more specific expertise in evaluating the plaintiffs in this case. However, we felt that our collective experience in the evaluation of trauma in forensic settings was specific enough for us to provide reliable opinions. At the time of the evaluations, each of the examiners had more than a decade of experience evaluating the effects of a wide variety of traumas in both clinical and forensic settings. Dr. Levin also had evaluated asylum seekers who had been tortured, and both Drs. Levin and Gold had experience in treating military personnel. It is unclear what advantage would have been conferred, except perhaps if the experts were specifically experienced in the area of military captivity and torture, not simply combat-related trauma. Setting a standard demanding that an expert's experience exactly match the case at hand seems unduly restrictive and would effectively exclude many of the forensic examinations performed by our colleagues. It should also be noted that plaintiffs’ counsel thought that because the action involved a tort against a sovereign state, U.S. government employees, including military psychiatrists, should not serve as experts because of possible perceived bias and/or conflict of interest.

We did, in fact, have the benefit of information gathered by a team of military experts familiar with POWs immediately upon the POWs’ repatriation and for a period of several years following their captivity (Ref. 2, p 319). Although Dr. Wettstein observes that prior records may be unreliable regarding the presence of trauma, the paper he cites involved a study of charts at a general psychiatric clinic⁴ and not records generated by trauma experts.

Finally, Dr. Wettstein expresses concern that information gathered by e-mail would be inherently flawed. We agree and noted in our paper that no opinions were expressed in these cases (Ref. 2, p 319).

• American Academy of Psychiatry and the Law