Ethnopsychiatry is today a contested field, in which concepts and terms such as ethnicity, identity, culture, citizenship, traditional therapies or symbolic efficacy are used in a very controversial way. Recent accusations of ‘racism’ against some ethnopsychiatrists have contributed to making more obscure the deep roots of these issues and controversies. Little attention has been paid to analysing the complex legacy of colonial psychiatry, as well as the relationships among current definitions of ‘culture’ and ‘belonging’, post-colonial subjectivities and migration. In this article, the authors briefly analyse the contributions of Italian ethnopsychiatry and investigate the hidden expressions of racism and prejudice still characterizing mental health workers’ attitudes toward immigrants. It is argued that a ‘generative’ and community-based ethnopsychiatry can challenge the hegemony of western psychiatry and improve the quality of therapeutic strategies.