looking at a simple causal relationship between conflict, violence and mental health, as many practitioners in Africa have observed.xxxvii Where mental health records are available for consultation, as in Northern Ireland for example, the psychological effect of prolonged conflict is not clear. Reactions to violence and torture are deeply intertwined with the meaning which people give to what has happened, with cultural and spiritual beliefs and with the ongoing context. An early series of studies gives some understanding of the morbid profile. In a study of former freedom fighters, it was found that the diagnostic breakdown did not strongly support the view that PTSD was the common form of psychological morbidity. There were strong similarities between the pattern observed in combatant and non-combatant survivors. Table 4: Diagnoses given to Mount Darwin Community survivors: Comparison with Zimbabwe War Veterans. PTSD Anxiety Depression Mixed Somatoform Emotional Disorder Disorder Mashonaland 24% 1% 21% 32% 21% Central [n=179] War Veterans 28% 4% 12% 33% 24% [n=53] It is worth pointing out, in the light of the more recent research cited above, that both Depression and PTSD were frequent diagnoses, but also it is important to understand that the equally high rates of Mixed Emotional Disorder (or what would be termed Common Mental Disorder in more recent terminology) and Somatoform Disorder. It is probable that a more carefully designed study would provide a different typology, but it also the case that Common Mental Disorders [CMD] have been found to be a substantial category of psychological disorder in primary care settings, and also that multiple symptoms are a very common presenting profile of persons with psychological disorder Zimbabwe. It is also worth pointing out that previous work on torture survivors in Zimbabwe suggested that the multiple symptom presentation seemed to cover both physical symptoms from pain due to chronic injury – back ache, for example - as well as the more common symptoms associated with psychological disorder – headache, stomach pains, etc.xxxviii There have been few clinical studies of character of psychological disorders due to OVT or PTE‘s. One qualitative study outlined the interactions between the psychological distress and the social disempowerment suffered by the survivors attending for psychotherapy.xxxix Amongst the men there was significant guilt at failing to protect themselves and their families, exacerbated by the impoverishment due to displacement that frequently accompanied the violence. And, furthermore, it was evident that the suffering was not merely individual or familial, but had profound consequences for the communities in which the violence had taken place, and for the forms of healing deemed most helpful by sufferers (typically spiritual). This is the destruction of ―social capital‖ indicated by Mollica and others that is a common feature of complex emergencies. Thus, there is a pressing need for good research into the nature of disorders due to trauma in Zimbabwe, of individuals, families, and communities, And there is equally a pressing need to examine critically the varied approaches to treatment that have been and are currently in use. This needs to include, as already indicated, both a broader assessment to include functionality, resilience and protective factors, a locally validated PTSD assessment tool, and indicators to help identify how villages and communities have been affected by events. With more focused assessment tools and a deeper understanding of the nature of trauma in Zimbabwe, it should be possible to build constructively on the extensive work done by the Amani Trust to research the effects of individual clinical work in primary care. As rising levels of distress can often be clearly linked to the deteriorating context, research is also needed to develop understanding of the kinds of social and community initiatives, and ways of working, including use of existing traditions and beliefs, which can be shown to result in improved psychological well-being..