Impairment of the ability to recognize facially expressed emotions was studied in 14 chronically disoriented patients with chronic organic brain syndrome (CBS). This impairment was named prosopo-affective agnosia (PAA). A diagnostic requirement was relatively intact neurologic functioning in underlying perceptual-verbal-motor processing. A test was designed for facial-affect recognition in the accurate differentiation of normal persons from chronically disoriented CBS patients. No normal subject made any errors in this test. Despite decades of illness and hospital living, patients with a history of schizophrenia or major affective disorders scored almost at a normal level (95 vs. 100 percent) in this test, and significantly higher (95 vs. 66 percent) than did the disoriented CBS patients. The social and therapeutic implications of the findings are stressed. CBS patients may be impaired with respect to receiving and appreciating elementary aspects of social communications such as recognizing a smile, anger, sadness or disapproval on the faces of people who surround them. This disability requires understanding and a special attitude on the part of the therapeutic team toward such patients.