Contemporary psychiatry finds itself in the midst of intense ambiguities. This work uses four types of parameters (historical, geo- politico-economical, cultural and technological) correlated with four domains (common tasks, recognizable clinical practice and research lines, acknowledgement of accomplishments, and well defined epistemological characteristics) in order to answer the question of whether a Spanish- speaking psychiatry does exist. The development of the psychiatric disciplines in Spain, Latin America and the Caribbean, and in the United States is reviewed, their different contributions, needs and problems are delineated. Latin American Psychiatry is characterized by its mestizo structure, its social emphasis and its critical approach. Hispanic psychiatry in the United States confronts real clinical and social needs as well as powerful professional political and economic forces. At the present time there does not exist a psychiatry based on the Spanish language or in the so- called Hispanic culture, even though such is quite a desirable objective. This psychiatry should combine a clear identity, a definite modernizing stamp, and emphasis on socio-anthropological and clinical research.