James Joyce's short story, "A Painful Case," relates Mr. Duffy's paralysis in his relationship with Mrs. Sinico and in his life generally. Before meeting Mrs. Sinico, he has a perfectly orderly existence, and has settled into a routine which is its own form of paralysis, repeating the same movements in the same places, eating the same meals in the same restaurants every day.

It is an effort for Mr. Duffy to further his relationship with Mrs. Sinico at all, even though it is an association so innocent that her husband encourages his visits. However, the first gesture of affection on her part, when she presses his hand to her cheek, causes him immediately to put an end to their meetings.

The one way in which Duffy progresses through his relationship with Mrs. Sinico is that she persuades him to write out some of his thoughts. He acquires two books by Nietzsche, the most aphoristic of philosophers, and writes, perhaps in imitation of Nietzsche's style:

Love between man and man is impossible because there must not be sexual intercourse and friendship between man and woman is impossible because there must be sexual intercourse.

It is ironic that the one permanent effect this chaste affair has on Duffy's life is to solidify his commitment to his own emotional paralysis. His writing, which might have led to some form of intellectual or emotional development, instead makes excuses for the lack of it. This is why he ends the story in perfect silence and solitude.