Appendix I is a case study supposedly printed from the British Review of Psychiatry, written by Wenn and Camia. It describes a homosexual “clinical variant” of de Clérambault’s syndrome, one that is eventually revealed to be Parry’s story. De Clérambault’s syndrome, or erotomania, can be traced from Ancient Greece through 1942, when de Clérambault gave it his name. In de Clérambault’s syndrome, or “pure erotomania,” the patient, usually a woman, is convinced that the object of her obsession, usually a higher-class male, is in love with her. She believes, despite his protestations or the obstacles between them, that their love is permanent. The patient usually believes that the object of her obsession was the first to fall in love and the first to make advances. De Clérambault’s most famous patient was a French woman who believed that King George V of England was in love with her. Since de Clérambault, other research has revealed that the sufferers can be male, and that males are likely to be more intrusive and more dangerous.
The case history describes a 28-year-old unmarried man “P” (Parry) who suffered from de Clérambault’s. P has had a lonely life—as a child he had few friends and even as an adult he had trouble making connections. He joined a religious group in college and dropped out quickly, but seems to have maintained a high degree of religiosity. He inherited a large estate from his mother and grew increasingly isolated, often meditating on “God’s glory” and preparing himself for God’s mission for him. During one of his walks he came across a balloon accident and shared a glance with one of the other men there, "R" (Joe Rose). P became certain that R was in love with him and that it was God’s will that he love R back and bring him to God’s love. P began to stalk R, sending him letters and believing that R was sending him signals in the curtains and the hedges. R was in a sturdy relationship with M (Clarissa Mellon), but P’s attentions put a strain on it, and R and M eventually separated. P was at first overjoyed, but when R still resisted P, P grew resentful and hired contract killers to shoot R, having learned his whereabouts from M’s stolen appointment book.
P’s plan fell through as the contract killers shot the wrong person in the restaurant. Overcome with remorse, P entered R and M’s home, holding M at knifepoint until R came home. When he did, P threatened to kill himself but failed. P was arrested for both crimes and the court ordered a full psychiatric report. Physical psychiatric tests failed to show anything wrong with P, who is still insisting that R loves him. He is coherent and articulate in these beliefs, even claiming that R is sending him “messages of love.” Despite therapy, P hasn’t changed in the past 6 months and is being held indefinitely at a mental hospital. P writes daily to R from the hospital, but the letters are not forwarded.
A discussion of psychiatric theories on erotomania follows. Pure erotomania often happens to socially inept, isolated individuals who live empty lives out of fear of rejection or intimacy. The important change in P’s life was his inheritance of the house—it let him cut all previous social ties and made him increasingly lonely. When he helped in the balloon accident, his previously “empty” life became one of teamwork, and P may have adopted his delusion as a method of avoiding going back to his social isolation. Like many forms of erotomania, P’s obsession contains the possibility for violence, and he had to be admitted to a mental hospital. The report concludes that P suffers from a relatively classic form of erotomania and that it may last for a while, calling it “a most lasting form of love.” R and M have reconciled and adopted a child.
Appendix II is a letter from Parry to Joe, written during Parry’s third year in the hospital. Parry tells Joe about his day—that he wakes up at dawn and looks out at nature, seeing God’s love and their love in the sunrise. This is his thousandth day locked up and his thousandth letter. Parry celebrates that Joe now realizes Parry’s hospitalization is for the best and, despite the dreary confines of the hospital, is happier than he’s ever been before. Parry thanks Joe for loving and accepting him, and reminds him to send a “new message soon” and that “faith is joy.”
Enduring Love, like many postmodern novels, has several endings. While the body of the novel ends with Joe and Clarissa’s picnic with Jean Logan, the novel’s content continues with two appendices: a fake psychiatric case study and another letter from Parry. This multiplicity of endings echoes Joe’s assertion at the beginning of the novel that there are many beginnings and that a beginning is an artifice. Following that logic, an ending is also an artifice, which is exactly what Enduring Love’s three different endings suggest.
When McEwan first published Enduring Love, he also submitted the fictional case study to the Psychiatric Bulletin. The case study wasn’t published, but another psychiatrist gave it a positive review, and several critics, both literary and psychiatric, assumed that the case study was real. The inclusion of the case study within the novel blurs even further the boundary between fiction and reality. Joe sets up the ambiguity of this division when he questions the veracity of narrative in the beginning. Each character constructs a narrative that to them makes the most sense of the actual events. Including this case study in the novel threatens the authenticity of science narratives, something with which Joe struggles throughout the novel.
The case study also provides a new point of view through which to view the events of the novel. In previous chapters we get Joe’s, Clarissa’s, Parry’s, and Jean Logan’s points of view. Here we have an ostensibly more objective way of communication, presented through scientific rationalism. Through this lens, we learn that Parry is still in love with Joe and that Clarissa and Joe have reunited and adopted a child. However, the objectivity of the “scientific” viewpoint is threatened by closely examining the study’s authors. "Wenn & Camia" is an anagram of "Ian McEwan," and with that wordplay, McEwan threatens the scientific narrative’s straightforward veracity.
The last of the endings, Appendix II gives the reader one last taste of Parry's viewpoint. In a short love letter, Parry reveals that almost three years into his stay in a mental hospital, he is still wildly in love with Joe. Parry's irrational voice is the last that we hear, and Parry's love seems to be the most enduring love of all. By including Parry's letter as the final element in the novel, McEwan challenges the more stable notions of love and knowledge. McEwan gives authority and finality to Parry's "dark, distorted" viewpoint, leaving the reader questioning what the book is actually saying about love.