The catastrophic reaction is a rare affective disorder following left hemispheric strokes. It is characterized by a disruptive emotional outburst involving anxiety, agitation and aggressive behavior. A case is presented that appears to underscore the intense frustration that these individuals experience when they cannot adequately express themselves through language. The catastrophic reaction behavior proved to be unremitting and failed to respond to withdrawal of the patient from threatening or difficult therapies, use of medications or attempts at behavioral modification. The catastrophic reaction appears to be a specific consequence of the intense frustration and perceived loss associated with an expressive aphasia. This may help explain the reportedly higher incidence of depression in left frontal strokes.