This paper examines human altruism and helpfulness and discusses how this can be theorized within psychoanalytic discourses. The importance and ‘naturalness’ of altruistic tendencies is described, and the effects of adverse experiences such as abuse and neglect on these capacities are examined. The paper integrates psychoanalytic thinking with neuroscience, attachment and developmental research and describes research which suggests that altruism and helpfulness are maybe more ‘normally’ present from an earlier age than might have been thought. It is argued that there are a range of ‘co-emerging’ capacities, such as empathy and understanding other minds, that lead to altruism and that in response to abuse and neglect such capacities often do not develop. Clinical example are used which describe patients who had suffered from adverse circumstances and who lacked empathy and altruistic tendencies, and some changes in them are illustrated.