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The title of this book suggests a state of ambivalence or indecisiveness in which a person is unable to decide between alternative courses of action equally attractive or distasteful. However, this everyday sense of the phrase is hardly Arnold Goldberg's topic in this brief but provocative book. Rather, he is describing a form of pathology in which two divergent states of mind, two self-organizations each with its own values and goals, exist side by side, one predominating over the other at any given time.
The work is an elaboration and extension of Kohut's concept of the vertical split. Kohut originally introduced the concept to deal with the oscillation between feelings of grandiosity and inferiority that is often observed in narcissistic personality disorders. What he formulated was a split between a better structured, more adaptive self and a fragmented, more pathological one. The two facets of the vertical split have more or less equal access to consciousness, and one is kept at bay by the other by the mechanism of disavowal. By contrast, the horizontal split uses the classical topographic model, in which unacceptable impulses and defenses are kept out of consciousness by the mechanism of repression.
Goldberg amplifies these ideas along a continuum from normal to pathological, amply illustrated by richly described case material. He uses Kohut's distinction between narcissistic behavior disorder and narcissistic personality disorder, but most of the cases he presents involve lapses and eruptions into behavioral realms. The prototypical vertical split, he argues, is seen in marital infidelity. While the several marital problems he presents differ in certain details, they all involve men who are unable to tolerate or find sufficient gratification in a monogamous relationship. One of the cases is reminiscent of the film Captain's Paradise, in which a man feels equally devoted to his wife and his mistress and wants to give up neither: “Dirk was of two minds, but this