In 1935 and 1936, Benjamin Malzberg, a prominent psychiatric statistician, published two intriguing findings concerning mental illness in New York. First, he found that the black rate of admission to state mental hospitals exceeded the white rate by a ratio of 2.3 to 1. Malzberg's statistical findings inspired others to seek explanations for this racial disparity, making similar comparisons with their own institutions. Initially, Malzberg speculated that the higher admission rates for African Americans demonstrated that their race was more susceptible to mental illness—especially severe psychosis. Such racial determinism was not unique. Since the antebellum era, psychiatrists and politicians tended to interpret black rates of disease as evidence of racial inferiority, no matter if such rates were higher or lower than white rates.

In 1936 Malzberg published his second finding: the majority of New York's mental patients had been born out of state, in the South mostly. In light of this new data, he recanted his earlier theory. He now let this second finding explain the first. He concluded that the “excess of the Negro rate in New York state must therefore be ascribed not so much to racial characteristics, as to the economic and other social difficulties to which a migratory population is subject.” He argued that so many blacks had been committed because urban life had been too stressful for rural migrants from the slower-paced South.

Although some critics were pleased that he abandoned racialist thinking, others were none too thrilled with his cultural mismatch argument. One critic was Dr. Ernest Y. Williams, an African American professor of psychiatry and neurology at Howard University. Williams did not doubt that black Southerners were overrepresented in the New York's mental hospitals. What he disagreed with was Malzberg's explanation of this racial disparity. Williams argued that the high rate of institutionalized blacks could best be interpreted as proof that uptown Manhattan, where most of the state's African Americans lived, lacked local psychiatric alternatives to the old asylums. Afflicted whites were less likely to end up in state hospitals because they had other mental health care options available to them. With most local care off-limits to African Americans, state hospitals were the primary placement option for mentally disturbed blacks.