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naddr1qv…da05As a neurophysiologist, much of my clinical work involves reading electroencephalography (EEG) — monitoring brain wave activity to detect seizures. Some seizures are electrographic: no obvious outward symptoms, but unmistakable patterns on EEG.
Our field’s most recent guidelines give an operational definition of an electrographic seizure:
Epileptiform discharges averaging ≥2.5 Hz for ≥10 seconds, or
Any pattern with definite evolution and lasting ≥10 seconds.
I’m well-trained to recognize this pattern and alert colleagues when it appears. But after reading thousands of EEGs, I’ve seen countless patterns that share many features of seizures — and may cause similar harm — yet don’t meet this definition.
It makes me wonder:
How critical are the boundaries we’ve drawn?
How well do they map to the underlying phenomena?
The conceptual definition of a seizure is “a transient occurrence of signs and/or symptoms due to abnormal, excessive, or synchronous brain activity.”
By that standard, there are some patterns that we recognize as similar but lack clear boundaries - ictal-interictal continuum patterns. However, there are still other events seen on EEG — cortical spreading depolarizations, focal evolving ischemia, event-related desynchronization — that appear to represent similar phenomena. Yet we don't think of them the same way, conceptually.
This isn’t just a medical issue.
It’s a philosophical one: the fallacy of reification — treating operational definitions as if they are the phenomena, rather than convenient models.
The Philosophical Roots of Reification
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The fallacy of reification has strong philosophical roots that have evolved to date. The ancient Greeks described the "Heap Paradox", where they described that if you remove a grain from a heap of sand, it's still a heap. If you keep going, where does it stop being a heap?
In Philosophical Investigations, Ludwig Wittgenstein dismantled the idea that all members of a category share a single set of necessary and sufficient traits. Using “games” as an example, he showed that categories often hold together through overlapping similarities, not rigid definitions.
In Ways of Worldmaking, Nelson Goodman argued that our categories do more than describe reality - they construct versions of it. Our operational definitions are flawed, but not because they are wrong about nature, but rather because they can be perceived to be the only way to carve up a continuous reality, when in fact they’re just one of many possible world-versions.
In The Logic of Modern Physics, Percy Bridgman argued that a scientific concept is synonymous with the operations used to measure it. This is powerful for precision, but he warned that operational definitions are context-dependent proxies, not the thing itself. They’re tools for communication and testing hypotheses. When we forget this, we reify them — treating the operational shortcut as if it were the literal reality.
https://i.imgur.com/kyOGSDT.png
Reification isn't just a philosophical curiosity - it's a trap that can freeze progress across many different domains - medicine, economics, morality etc,. The moment we forget that our definitions are models, not the phenomena themselves, we stop asking the right questions.
Seeing the spectra behind the label is the first step toward solving the problems our definitions don't allow us to see.
Why This Matters in Medicine
Operational definitions carry value in that they can help us establish a foundation of new phenomena. The operational definition of an electrographic seizure allowed us to do important studies that showed that electrographic seizures are common in brain-injured patients, and that they are associated with metabolic crises and worsened outcomes. This has helped improve the way we monitor and treat these seizures in neurocritical care.
Another important operation definition in the neurocritical care world is cerebral perfusion pressure (CPP). An important goal in caring for the brain-injured patient is make sure they have appropriate blood flow going to injured parts of their brain. We historically have not had great technology to continuously monitor blood flow in the brain, but we developed an operation definition of cerebral perfusion pressure (CPP) to represent the difference between mean arterial pressure (MAP) and intracranial pressure (ICP). Again, this operational definition provided foundational science that showed that low calculated values of CPP are associated with worsened outcomes in brain injured patients. However, I've encountered situations where a rise in ICP may be caused by too much blood flow in the brain (identified through evidence of cerebral hyperemia using transcranial Doppler ultrasound). These are situations where the operational definition defies the conceptual definition.
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In using operational definitions dogmatically, we have run into a ceiling in our progress. We have no high-level randomized controlled clinical trials that show us that treating electrographic seizures improves outcomes, nor do we have similar trials demonstrating that improving calculated values of CPP improves outcomes. Why is it then, that we can see these strong associations to outcomes in observational studies, but yet we haven't figured out a way to translate this information to high-level therapies?
Fundamentally, we want to treat seizures in brain injured patients to reduce the cellular damage that can occur from abnormally firing brain activity. We want to provide adequate blood flow to the injured brain, not just target a number formed from an equation.
If we mistake our operational definitions for the phenomena themselves, we risk optimizing the map while ignoring the territory. In doing so, we may miss the very mechanisms we set out to heal.
Why This Matters in Economics
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Like I said, the fallacy of reification matters to more than just medicine. Let's take on the issue of money.
Money serves two fundamental purposes: it is both a medium of exchange and a store of value . As Jack Mallers eloquently describes, money is our time and energy in abstracted form. It is a unit of account of our stored energy that can be transformed across space and time. Every country, however, characterizes money as a unit defined by government decree, and backs it by trust in that governmental authority. When we accept this, we fall into the trap of reifying it.
By mistaking the symbol for the thing, we risk building economic policy - and personal financial decisions - around the nominal count of dollars rather than the real purchasing power that we intend for it to secure. In our world, we experience skyrocketing inflation, where the price of goods and services increase beyond nominal wages for most individuals. People are struggling to save money, and younger people are crippled with debt and without the means to improve their financial situation. Across the world, governments act together in setting monetary policy that is inflationary in nature, where global debt grows and each generation has to work more to obtain less than their predecessors. We might see assets and wages go up in terms of a government currency, and we think that they actually went up in value. The fallacy of reification can create an illusion of value.
https://www.youtube.com/shorts/s2QbMswLEN8
The Call to Action
Operational definitions can provide us with the foundation to create models and solve some of our problems, but they also can limit us to further progress if we don't understand what we create. If we want to solve our hardest problems - in medicine, economics, or ethics - we must
Recognize our definitions as tools, not dogma
Question whether our operational cutoffs capture the underlying phenomena
Return to first principles, our foundations, and follow the signals
Reification hides the invisible spectra. Our job is to see beyond the bins we've built - and act on the phenomena themselves.
References
Hirsch LJ, Fong MWK, Leitinger M, et al. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version. J Clin Neurophysiol. 2021 Jan 1;38(1):1-29.
Foreman B, Claassen J. Quantitative EEG for the detection of brain ischemia. Crit Care. 2012 Dec 12;16(2):216.
Hartings JA, Shuttleworth CW, Kirov SA, et al. The continuum of spreading depolarizations in acute cortical lesion development: Examining Leao's legacy. J Cereb Blood Flow Metab. 2017 May;37(5):1571-1594.
Williamson TR. Vagueness. London, UK: Routledge;1994
Wittgenstein L. Philosophical Investigations. 4th ed. Chichester, UK: Wiley-Blackwell; 2009
Goodman N. Ways of Worldmaking. Indianapolis, IN: Hackett Publishing Company; 1978
Bridgman PW. The Logic of Modern Physics. New York, NY: Macmillan; 1927
Alkachroum A, Appavu B, Egawa S, et al. Electroencephalogram in the intensive care unit: a focused look at acute brain injury. Intensive Care Med. 2022 Oct;48(10):1443-1462
Vespa P, Tubi M, Claassen J, et al. Metabolic crisis occurs with seizures and periodic discharges after brain trauma. Ann Neurol. 2016 Apr;79(4):579-90.
Brasil S, Panerai RB, Bor-Seng-Shu E, et al. Point-Counterpoint: Cerebral Perfusion Pressure Is a High-Risk Concept. J Cereb Blood Flow Metab. 2023 Nov;43(11):2008-2010
Mallers J. Money is Your Stored Energy Across Space and Time. YouTube.
https://www.youtube.com/shorts/s2QbMswLEN8**
. Published January 30, 2025 by Natalie Brunell. Accessed August 14, 2025.
BrianAppavu on Nostr: My latest article tackling a concept I wrestle with, but very few talk about: the ...
My latest article tackling a concept I wrestle with, but very few talk about: the fallacy of reification.
