Paul's Case has been called a "gay suicide".[9] Many critics have attributed his suicide to the forces of alienation and stigmatization facing a young, possibly homosexual, man in early 20th-century America.[10] In 1975, Larry Rubin wrote The Homosexual Motif which includes the reinterpretation of the story since the stigma on sex has eased. He identifies small details which he claims support a gay reading of Paul. For example, Rubin refers to the way Paul is described as "dressing as a dandy".[11][12] The violet water (a perfume Paul owns), and his choice of company are construed as signs of feminine tendencies.[13] Jane Nardin also explores the possibility that Paul's character is gay, and that this is a metaphor for a general feeling of being an outsider or not fitting in with a specific group of people.[14] Author Roger Austen states that Paul might be understood as a homosexual character because of the "depiction of a sensitive young man stifled by the drab ugliness of his environment and places the protagonist in an American literary tradition of 'village sissies'".[15]
Wayne Koestenbaum reads the story as a possible portrait of Willa Cather's "own desire for aesthetic fulfillment and sexual nonconformity".[16] Another critic, Tom Quirk, reads it as an exploration of Cather's belief in the "irreconcilable opposition" between art and life.[17]
In response to Michael Salda's "What Really Happens in Cather's 'Paul's Case'?", where Salda says Paul did not kill himself, Martha Czernicki suggests, in "Fantasy and Reality in Willa Cather's 'Paul's Case'", that Paul's trip to New York is a fantasy or dream, but his suicide is not.[18]
James Obertino of the University of Central Missouri suggests that Paul may suffer from post-traumatic stress disorder.[19]
Hayley Wilhelm of the University of New Haven, suggests the possibility that Paul has autism due to certain signs and symptoms he displays throughout the story.[20]
Rob Saari, in "'Paul's Case': A Narcissistic Personality Disorder",[21] considers whether the main character, Paul, has a Narcissistic Personality Disorder. The DSM-IV essential features match the personality traits that Paul had throughout the story. Saari also suggests that because of this disorder, Paul needs to associate with people of a higher class, and that Paul "shows traits of vanity". He also talks about how difficult it is for the reader to feel bad for Paul because of how he acts in the story. When actually looking back and seeing how much Paul was struggling it's much easier to sympathize with him. Paul is clearly both unaware and unable to control the way he acts and feels. Examples Rob Sarri uses to support his claim include: Paul not caring about school and being more focused on his job, Paul stealing money from his employer to go away and live out his dream, and Paul killing himself in the end rather than confronting his reality.
David A. Carpenter, describes how Willa Cather was just starting to enjoy city life, which could be the reason "Paul's Case" and "A Wagner Matinee" were so heavily focused on cities like New York and Boston. He states "They also come when Cather is still extolling the big-city cultural life before she learned to love the bleaker environment and warmer people of the American Midwest that she later wrote about in short works and novels that made her famous". In addition, Cather made alterations to the title, paragraph simplification, punctuation and dictation based around her state of life and surroundings 15 years after publication. Similar alterations were made to her other works, such as "A Lost Lady" and "The Professor's House".[22]
