During the third largest outbreak of botulism reported in the United States, affective responses of patients and their family members were assessed to monitor and compare the emotional distress experienced by the two groups during the initial, acute phase of the life-threatening illness. Ratings of 12 patients and 16 family members indicated that family members were significantly more fearful and depressed than patients during the first week and as fearful and depressed as patients during the second week of hospitalization/treatment. Anxiety and helplessness decreased significantly in both groups by week 2. Results illustrate the impact of catastrophic illness on the entire family system and provide support for the utility of family-oriented, crisis interventions. In future outbreaks of catastrophic illness, the early identification of emotional distress and informational needs and provision of appropriate counselling to family members as well as patients may be clinically indicated and valuable in facilitating the coping process.