Stacksteder (1989) stated that there are people who experience "estrangement and alienation" between their psyche and soma. They may perceive the soma as persecutory, an embarrassment, and shameful. The soma may be trying to annihilate the psyche, or the psyche to control the soma; they are in a sadomasochistic relationship at war with each other. The self and body are seen as distant entities rather than a psychosomatic unity. Sacksteder says, "rather than being identified with their body, liking it, enjoying it, caring for it, nurturing and developing it, they hate it, and cruelly, unrelentingly attack it. They even starve it to death" (p. 38). This book supports the contention that, "When an infant lacks a healthy maternal representation for internalization and soothing purposes, the infant does not have the capacity to differentiate or regulate overwhelming affects or intense bodily discomforts. In addition, lack of consistent care and proper handling regarding all aspects of the baby's body becomes another contributing factor in shaping body dysmorphia... The inability of the mother to provide adequate homeostatic regulation can greatly affect the developing psyche... When the child's internalization of the maternal caring functioning is experienced as punitive and prohibiting, there is difficulty in accepting and tolerating one's affects... Faulty maternal attunement in the early oral phase can affect the child's ability to symbolize or put feelings into words. Thus, these patients present with a multitude of bodily symptoms that communicate and speak to their disturbed psychopathology."