Kellermensch: Living With the Emotional Weight of a Career in Health Care

When Machine Head frontman Robb Flynn sings these words, you don’t need to be a fan of metal music to hear that he’s singing from the heart. Trying to heal. Trying to process the emotions resplendent in the human condition. The extremity of heavy metal allows for extreme emotions, and that’s what makes it powerful—“it doesn’t shy away from big emotions…heavy metal will never tell you that you are too much, because by definition, it is too much”²—You may be saying to yourself, “That’s great, Joe. We’ve indulged your mental side roads before. How do Robb Flynn’s emotions, anguish, and need for catharsis relate to oncology pharmacy? What does ‘kellermensch’ even mean?” Patience, my friend. But if you absolutely can’t wait, jump ahead to paragraph 5 to learn about kellermensches. At least, I think that’s the plural of kellermensch—but my German is rusty, and I digress.

Heavy metal and kellermensches connect to oncology pharmacy because humans are emotional beings. We feel, react, respond, and process. Research performed by Antonio Damasio shows that our emotions are critical to making even simple decisions. Removing emotions from the decision-making process leads to indecision (the proverbial analysis paralysis) and poor choices. Emotional responses act as a kind of shortcut, helping us quickly condense experiences or make choices without being immobilized by the infinite options of our age.³ It’s clear that we need our emotions. It’s also clear that we lead with our emotions more often than we realize or consciously will admit. So how, then, do emotions apply to oncology pharmacy? Just this: We are human, and so are our patients.

Think of the emotions you experience in a typical workday. I’ll go first: Joy. Sadness. Anger. Depression. Sympathy. Anxiety. Confusion. Excitement. Fear. Surprise. Relief. And that’s all before 11! In daily practice, we forget that emotions are not weaknesses, or flaws. They are natural, present, and necessary. Emotions are the weather of our brains. Without them we would be merely overwhelmed robots. It’s not just we who have emotions: It’s also our patients, colleagues, friends, and family. We connect with others and form relationships based on the emotions of shared experiences or passions. Consider a patient that you cared for who made an impact on you. Someone you connected with, even though your human resource officer warned you that it was a bad idea. After all, we’re in cancer care. We’re not supposed to form connections with our patients. It’s not a “best practice.” But you didn’t listen, did you? (I sure as hell didn’t). I’ll let you in on a secret: Best practices aren’t actually the best. By definition, they’re average!

Having emotions enriches the tapestry of human existence. You’ll notice I didn’t say having “positive” emotions enriches the human experience. Nor did I say that “negative” emotions detract from it. Emotions don’t come with labels: They are simply what they are. We are the culprits who label them as positive or negative when in reality they are neither. How did you feel when that patient passed away? It’s natural to feel sadness when a patient dies. It’s just as natural to feel anger that the overall system that is supposed to help patients isn’t always doing that; or joy when a patient completes treatment; or confusion navigating policies and procedures designed to shield organizations instead of serving patients; and depression when moral injury results from being forced to act in ways violating your values.⁵ Even anxiety that you’ll be fired if you speak up about an issue. All of these emotions are natural.

What’s not natural is repression. Extreme skier Kristen Ulmer uses the analogy of locking uncomfortable emotions (fear, anger, sadness, etc) in the cellar of your brain.⁴ But we can’t lock these emotions away—they don’t disappear over time. Instead, these repressed emotions never mature. That in turn causes the immature emotions to act out and find disruptive ways to attract your attention—the opposite of your original goal! As Nietzsche says, “for when you gaze long into an abyss, the abyss gazes also into you.”⁶ Or put another way, you become the kellermensch, the “cellar person.”

Only by integrating with these emotions can we create a healthy relationship with ourselves. Hiding your emotions from others in a professional setting can present tactical advantages. But hiding them from yourself is a child’s answer. It is akin to cleaning your room by shoving everything under your bed or into the closet and hoping no one notices. It is a focus on how you want to see yourself instead of how you really are and not based on anything of actual substance.

Very well, you say. But this all makes me uncomfortable—we pharmacists like science, black-and-white options, clear paths of action. Gray areas aren’t always our forte, so these emotions and addressing them is all very…foreign. You know what? I get it. I’ve been there too. So, let’s try putting emotions into more “scientific” terms.

The second law of thermodynamics states that “the entropy (disorder) of a closed system will always increase over time.” A closed system is where nothing comes in or out—for example, the mental cellar where we confine our emotions. If we ignore these emotions, their mental entropy can only increase, causing us confusion and disorder. Think of entropy here as the opportunity to do work: High entropy equals a mess that will take energy to clean up. We have to do the work to counteract the emotional entropy.

The world of physics gives us Heisenberg’s uncertainty principle, which states that we cannot know both the location and velocity of a particle at the same time.^7,8 It’s one or the other. Applying to the world of emotions, this tells us we can’t predict the changes or sparks of an emotion. A key part of Heisenberg’s principle is that there has to be someone “observing” for the uncertainty to be real. Translation: The uncertainty we feel watching our own emotions is directly correlated to how much we interfere with the emotions. For example, thinking “I have nothing to be sad about! Why am I depressed? It makes no sense!” creates more uncertainty for us than acknowledging our emotion. When we realize we’re watching our own emotions, the uncertainty of the emotions can lead to erratic behavior (ie, acting “emotionally”).

So, what’s a thinking, feeling oncology pharmacist to do? The answer is here in front of us. We need to 1) acknowledge, 2) honor, and 3) engage with our emotions as part of our emotional reality. The truth of existence is that emotions have their own weight we must carry. We need to allow ourselves to feel our own emotions, and those of others. To sit with and process them. Sitting with an emotion takes time. So does processing. Will it be easy? No. But as author Ryan Holiday states, “Remember that this moment is not your life. It’s just a moment in your life.”

We all process emotions uniquely. I am a physical processor; to fully engage with my emotions and learn from them, I need to be active and moving. My mental health depends on having something hard to push against. It could be rock climbing long routes in the alpine, it could be trail running, it could be a garage workout, or it could be the mosh pit at a concert. What links all those together is physical activity allowing me to process the emotional weight. It’s even more potent if the physical activity is something I’m not sure I can complete successfully. Traversing through the brain’s liminal space sets me right again. No doubt you have your own methods, and I’d love to hear them. What’s important is that you make the effort. You have to do the work. I argue that ignoring your emotions and their weight is irresponsible. Acknowledging and processing them is not something anyone else can do for you. Only you are able to do it. And it is something you can do. When it comes to personal growth, shortcuts always take you someplace else. As you journey through your emotions, remember the goal is not:

Brain > Heart

Or

Heart > Brain

But

Heart + Brain = Whole

REFERENCES

1. Machine Head. “Darkness Within.” Roadrunner Records. 2011.

2. LaRocco M. “Extreme Healing: The Catharsis of Heavy Metal.” TEDxBellarmineU. February 2021. Accessed August 26, 2025. https://www.ted.com/talks/michael_larocco_extreme_healing_the_catharsis_of_heavy_metal

3. Lerner JS, Li Y, Valdesolo P, Kassam KS. Emotion and decision making. Annu Rev Psychol. 2015;66:799-823. doi:10.1146/annurev-psych-010213-115043

4. Dean W, Talbot S, Dean A. Reframing clinician distress: moral injury not burnout. Fed Pract. 2019;36(9):400-402.

5. Ullmer K. The Art of Fear: Why Conquering Fear Won’t Work and What to Do Instead. Harper Wave; 2017.

6. Nietzsche F. Beyond Good and Evil: Prelude to a Philosophy of the Future. Hollingdale RJ, trans. Penguin Books; 1990.

7. Wheeler JA, Zurek WH, eds. Quantum Theory and Measurement. Princeton University Press; 1983:62-84.

8. Heisenberg W. Physics and Philosophy: The Revolution in Modern Science. Harper; 1958.

9. Holiday R. The Obstacle Is the Way: The Timeless Art of Turning Trials Into Triumph. Portfolio; 2014.