"Paul's Case" is the story of the artistic soul struggling for survival in an artless world.
Cather's theme of how stultifying Calvinism and the new technology after the Industrial Revolution drowns out the aesthetic side of people is conveyed through setting. Symbolizing Paul's longing for love and sentiment in his life is the embroidered hanging of "red worsted" worked by a mother he does not even remember. This hanging depicts George Washington and the words of John Calvin, symbolizing his deprivation of love and the absence of sentiment and beauty that is absent in his life. Critic David Carpenter writes that Cather places these pictures on Paul's wall to stress that
...the uncreative, superficial and life-destroying values perpetuated in the homes of Pittsburgh are essentially American values.
Living in one of the industrial capitals of the United States, Pittsburgh, is Paul, who sits on the lowest step of the front "stoop" on Sundays as his father talks with neighbors. While most of the conversation does not interest him because it is about the steel industry and money, Paul enjoys hearing of the "legends of the iron kings," whose money buys them passage to Venice and sail on yachts on the Mediterranean. But, this narrative is interrupted by the other men who discuss mundane issues.
This industrial, insensitive world is what Paul rejects; instead, he eschews what he considers "the guise of ugliness." Paul seeks "the fairy world of art" that has "all the allurement of a secret love" because this world feeds his artistic soul that of his teachers only the "drawing-master" has recognized. He sits long hours in the theaters and he frequents the picture gallery at the concert hall, losing himself in the delight of envisioning the streets of Paris and Venice, centers of great art culture.
The theater and Carnegie Hall are where Paul feels he "really lives." This world is Paul's "fairy tale." And, this world is where the natural one seems ugly to him because Paul feels that "a certain element of artificiality seemed to him necessary in beauty." This, too, is an environment which Paul finds impossible to give up as it provides him a "delicious excitement" that stirs his heart and feeds his soul. Outside of this environment, Paul is surrounded by what he perceives in the school and home in Pittsburg as an antagonist setting, one that would steal beauty and aesthetic pleasure from him.