Nuthouse. Aftermath. Dean sneaks into Sam's room to find his brother wallowing in a Ginormotron-sized K-hole. Or, you know, a reasonable facsimile thereof. There follows a completely pointless conversation because Dean is sober (albeit increasingly insane) and Sam is on every drug the nuthouse pharmacy could provide on such short notice (albeit also increasingly insane), so we'll be skipping ahead to the point where Dean bow-leggedly clompy stomps through the funny farm's halls until he suddenly finds himself talking to himself again, and here's where things start to get interesting, because Dean's increasingly insane subconscious suddenly decides to turn on him, blasting him with taunts and contempt. "Whee!" "You can't save everybody," Doctor Dean commiseratingly sighs before flipping her switch from "Kindly Compassionate Health Care Professional" to "Delightfully Nasty Ball-Busting Bitch." "Hell," she smirks, dropping her voice an octave while fixing him with an icy glare, "these days you can't save anybody, Dean." "What'd you say?" Patient Dean blinks. "The truth!" Doctor Dean spits. "You got Ellen and Jo killed, you shot Lucifer but you couldn't gank him, you couldn't stop Sam from killing Lilith, and, oh! Yeah! You broke the first seal!" Sweet. By the way, the underscoring on the soundtrack's doing some wonderfully disorienting things as Doctor Dean really gets rolling with the abuse while Patient Dean stands there slack-jawed, utterly unable to comprehend what's going on at the moment. "All you do is fail!" Doctor Dean continues. "Did you really think that you, Dean Winchester, 'with a GED and a give-'em-hell attitude' were gonna beat The Devil? Please. The world is gonna burn, and there is nothing that you can do about it!" "Who are you?" Patient Dean growls, finally finding his voice. Or, you know, his half of his voice. "How do you know that stuff?" he shouts, getting all up in her nonexistent face. This, of course, attracts the attention of a nearby orderly, who at first just wearily calls out for Dean to keep it down, but eventually, the guy's forced to walk over and point out that Dean's been screaming at thin air. Doctor Dean leaves Patient Dean with one last needling gibe before vanishing for good, and Our Intrepid Hero staggers off down the hallway in a growing panic, seeing Wraiths staring back emptily at him from every reflective surface before he finally loses control of himself and curls up into a wee little hyperventilating ball of angst and fear. Kick ass. By the way, they included a blink-and-you'll-miss-it shot of Nurse Diesel smiling softly to herself over Dean's obvious distress. You know. Just so you're aware. "EEEEEEEEEEEEE!"