Pulvinar activation has been observed while viewing fearful expressions, but the necessity of this activation to their recognition has not been previously assessed. We measured the processing of emotional facial expressions in a rare patient with complete unilateral loss of the pulvinar. With brief presentations, patient CJ was incapable of recognizing fearful expressions in his contralesional field. Three other patients, with damage limited to the anterior and to the lateral pulvinar, showed no deficits in recognition. In conjunction with anatomical studies of the monkey pulvinar, these results suggest that fear recognition is mediated by the human medial pulvinar. We outline the possible role of the pulvinar in fear recognition, considering both the pulvinar's direct and indirect cortical connections with the amygdala, and we suggest that the integrative role of the pulvinar may be primary. Our results suggest that the cortex in isolation from the entire pulvinar is incapable of recognizing fearful expressions.