Miranda July’s All Fours shatters the silence around perimenopause, exposing it as a raw, radical transformation that rewrites a woman’s body and mind. All Fours is a semi-autobiographical novel that draws from Miranda July’s personal experiences, reflecting her signature style of blending vulnerability with conceptual experimentation. As a multidisciplinary artist, July’s background in performance and visual art informs the novel’s exploration of selfhood, turning her life into a platform for creative inquiry and social commentary. As a psychotherapist specialising in women’s health, I’ve observed that the perimenopausal phase is frequently glossed over, even in clinical settings. It’s a time marked by profound biological and psychological transitions, yet remains largely relegated to the shadows. July’s All Fours is a striking exception, tackling perimenopause with an incisive honesty that is as rare as it is necessary. Her work confronts the complexities of this stage of life—one where bodily transformations intersect with shifting psychological landscapes, yielding an often disorienting yet potentially transformative experience.
Perimenopause: The Nexus of Change
Perimenopause represents a critical juncture in a woman’s life, often manifesting in multifaceted physiological symptoms such as vasomotor instability, sleep disturbances, and cognitive fog, as well as psychological manifestations like anxiety, irritability, and mood fluctuations. July captures this nexus of change with unflinching clarity. Her characters are not passive recipients of these shifts; they are active participants in the tumultuous process of redefining selfhood amidst hormonal and emotional upheaval. This mirrors what I see in my clinical practice—perimenopause as an unfolding process of reorganisation, not simply in terms of identity but also in how women relate to their bodies and their social worlds.
In All Fours, July eschews the often reductive narrative that surrounds this life stage—one that typically reduces perimenopause to a set of medical symptoms requiring management. Instead, she offers a more layered portrayal: perimenopause is shown as a moment of dissonance and rupture, but also one of potential psychological growth. Her characters wrestle not only with the physical vicissitudes of this phase but also with the existential questions that arise as they confront the evolving landscape of middle age.
Psychological Realms: Disintegration and Rebirth
July’s exploration of perimenopause can be understood as a deep psychological process of transformation, marked by a breakdown of the old self and the potential for reorganisation and growth. This phase often brings long-buried desires, unresolved conflicts and anxieties to the surface, forcing individuals to confront parts of themselves they may have previously ignored or suppressed. The heightened emotional vulnerability that emerges during this time can feel disorienting, yet it also provides an opportunity for deeper self-awareness.
In this sense, perimenopause reflects the broader life-death-life cycle, where the old self must “die” to allow a new, more integrated self to emerge. As the ego is challenged by the losses associated with ageing, such as shifting roles and physical changes, it is also an opportunity for redefinition. July’s characters reflect this process, resisting static or idealised versions of themselves and instead embracing the fluidity of selfhood. This stage is often marked by ambivalence—women may mourn the loss of youth and reproductive capacity while simultaneously feeling a sense of curiosity and hope for what comes next.
Clinically, this ambivalence is vital to recognize. Women at this stage often express grief over the closing of certain chapters in their lives, but they also express excitement about the potential for new beginnings. This period of transition and redefinition requires a nuanced approach in therapy, acknowledging both the losses and the opportunities for growth that come with it. July’s narrative powerfully encapsulates this duality, reflecting the psychological complexity of this life stage.
The Somatic Experience: From Embodiment to Alienation
Another salient theme in All Fours is the evolving relationship women have with their bodies during perimenopause. July deftly portrays the alienation many women experience as their bodies become unfamiliar territory, subject to hormonal changes that seem beyond their control. This sense of estrangement is often a clinical issue I encounter, where women report feeling “betrayed” by their bodies—where previously reliable systems of regulation now seem unpredictable and chaotic.
From a somatic perspective, the transition of perimenopause often requires a reorientation toward the body, not as a site of dysfunction but as a shifting terrain to be understood anew.
The Importance of Clinical Training in the Menopause Transition
At BRIA, we recognize the need for health care providers to be well-equipped to support women through these life transitions, which is why we offer specialised clinical training on perimenopause and menopause. Proper training empowers clinicians to meet the unique needs of women in this phase, offering not only medical but also psychological support.
By raising awareness and enhancing the skills of healthcare providers, we can ensure that women receive the comprehensive care they deserve. The themes explored in All Fours remind us of the critical importance of recognizing and addressing the complexities of perimenopause in both therapeutic and healthcare contexts. Offering clinicians the tools to navigate this sensitive stage can profoundly impact the quality of care women receive, fostering greater understanding and support during this often challenging life phase.
