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"On All Fours" is not an episode of Girls for the faint of heart. Hannah, Adam, Shoshanna, and Marnie all seem very intent on inflicting pain on themselves and those around them.
Hannah is regressing further with her OCD symptoms. She has a very stressful meeting with her publisher who tells her that what she has written so far is uninteresting. He says he wants her to write about her sexual escapades, and if she isn't partaking in any she should just make it up.
Already stressed out, the meeting is more than enough to send Hannah into a downward spiral. It all begins when she gets a very painful looking splinter, and the removal process turns into her cleaning out her ear far too enthusiastically. She pops her eardrum with a Q-Tip, and after calling her parents goes to the hospital alone. The audience feels Hannah's pain during this scene, and it is only more difficult to watch when we realize she has no one to take her to see a doctor. She clearly still has more to work out at the end of the episode, as we see her "making things even" by popping her other eardrum.
Adam seems to be happily moving on from Hannah into his new relationship with Natalia. Things are going very well between them, until Natalia invites him to a friends engagement party and Adam decides to drink after a slightly awkward and unexpected encounter with Hannah. Adam had mentioned in the episode last week during his AA meeting (where he met Natalia's mom) that he was feeling less strong about his will to stay sober. His self-destructive behavior continues, as he and Natalia return to his apartment where he subjects her to sex she very clearly doesn't enjoy. Things may be over between the two of them, as Adam realizes he may have sabotaged their relationship.
Shoshanna is dealing with some inner turmoil of her own. She seems to feel guilty about cheating on Ray with the doorman, but also is clearly starting to feel less enthusiastic about their relationship. Ray berates Charlie at his own work party, and Shoshanna spends the rest of the night talking to other guys. Ray finally confronts her for acting odd and she just tells him she feels bad because she held hands with the doorman. He laughs, says he loves her so much, and she responds with a cringe. Shoshanna may have to work up the courage to end things with Ray before things get worse.
Finally, though she might be the least self-sabotaging of the lot, Marnie still partakes in her own questionable behavior. She is still adamant about pursuing a career as a singer, and at Charlie's work party she sings a cover of Kanye West's "Stronger" to a puzzled crowd. Charlie pulls her aside afterwards and asks if she needs help, that she seems almost manic. Marnie calmly responds that she is fine, she is simply following her dreams. The conversation ends when they start having sex in a not-so-obscured office.
Overall, "On All Fours" was an an episode of cringes and regressions. Hopefully sometime soon these four characters will realize that "no pain, no gain" doesn't have to be the motto by which they live their lives. Until then, we may have no other choice but to suffer through it with them.