It's been a while since we last saw the boys, and if you recall, that's when they failed to stop the Devil from raising another Horseman: Death. Along the way, they lost Ellen and Jo Harvelle...sniff.
The scene opens at Glenwood Springs Psychiatric Hospital, Ketchum, Oklahoma. A doctor looks at a file that includes a news article about a boy dying in a house fire, and asks a patient why she's not taking her meds. She explains that the pills make her sleepy, and if she sleeps "it'll come." She's talking about a monster. The doctor explains that she's schizophrenic, and she says she knows what she is, that she hallucinates things like her dead son. But the monster is real, and killed her roommate Annie.
The doctor contends that she must be having a hard time dealing with Annie's loss, but the woman, Susan, insists the monster is no vision. "I can hear it at night, in the walls. Please," she begs, "You have to believe me."
Naturally he doesn't. Later, when the lights go out, Susan crouches in the corner, her arms crossed protectively across her torso, and hears claws scampering inside the the ceiling heating ducts. Above her the screws start to come out of the ventilation screen. She screams, runs to the door and cries for help, but the orderlies ignore her, grumbling about the patients starting early. Susan pounds on the door, and the patient across the hall sees her and watches, helplessly, as she's dragged back into the darkness of her room, yelping. When the orderlies inspect her room the next day, they find her on the ground, dead in a pool of her own blood, her wrists slit.
Looks like a job for the Winchesters! Sure enough, the boys are soon sitting across the table from the same doctor who abandoned Susan, with Dean attempting to admit Sam using a fake reference from a Dr. Babar.
The Doctor is suspicious, pointing out that Babar was a children's book about an elephant, but Dean plays ignorant. The doctor asks Sam how he's been feeling, and Sam contends that he's fine. A little depressed, he guesses...probably because he started The Apocalypse. Come again? The doctor asks.
So Sam tells their story straight, talking about Ruby, Lilith, hunting demons, and all about Castiel. Dean adds that he just wants his brother to get better so he can go back to hunting demons with him. The Doctor smiles, gets on the intercom and asks his assistant to cancel his next appointment. Soon after, Sam and Dean are walking down the hall with a cute, young nurse who informs them the doctor wants to keep both of them for observation. She gives both of them an exam, including aspects involving the snap of a latex glove...and they're in.
Dean and Sam reconvene in the day room with the rest of the patients and we find out why they've gotten themselves institutionalized: There's a hunter there, Martin, who helped their dad out in the past. Additionally, Sam's a bit worried that Dean hasn't shows any signs of mourning Jo and Ellen over the past few weeks when apparently nothing has been going on. Sam's worried that Dean's keeping it bottled up and tells him, "You can't just keep this crap in."
"Watch me," Dean snarls, then spots Martin. He's very happy to see them, and sits them down and tells them about the monster. He adds that in the old days, he could take care of this thing easily but now...then he fills them in. Five deaths, all deemed suicides by the hospital. Dean asks Martin if he's seen the monster, and the old hunter admits that he hasn't, that he's only heard reports about the sounds from other patients. As one woman dances in her own reality behind them, Dean questions the reliability of said reports.
The doctor joins them and congratulates the boys, who he knows as Alex and Eddie, for making friends, and invites them to join everyone else for a group session. Sam and Dean get up to join Martin in the group, but the doctor tells Dean to hang back -- he'll be in an afternoon group.
"The relationship that you have with your brother seems dangerously co-dependent," the doctor explains. "I think a little time apart will do you both good." Hmm.
In group therapy, a patient -- the man who was across the hall when Susan was killed -- wants to talk about "the monster hunting us." He insists it's real and gets the other patients riled up, but the doctor shuts him down, insisting that there is no monster and that he needs to behave. The man clams up nervously, and as Sam watches all of this with interest, Martin shoots him a knowing look.
Meanwhile, Dean meets the doctor assigned to his case, and attractive brunette named Dr. Erica Cartwright.
"You're my shrink, huh?" he says, turning on the charm. "Lucky me."
"And you're a paranoid schizophrenic with a narcissistic personality disorder and religious psychosis," she replies, unmoved by his winning smile. "Lucky me."
She sits down to ask him some questions, and he starts things off with a Hannibal Lechter impersonation. Dr. Cartwright is not entertained. They agree to answer each other's questions, quid pro quo.
She asks how many hours he sleeps a night. His answer: Three or four, every couple of nights.
He asks about the suicides, and if she's noticed anything strange like black smoke or sulfur. She asks what that's supposed to mean, and he explains that they're demons signs.
She: How many drinks does he have per week? He: Well, gotta sleep sometime so "I don't know, it's somewhere in the mid 50s."
He: Ever felt any cold spots around the hospital? That's the sign of a ghost. She says no.
She asks when the last time was that Dean was in a long term relationship, as in more than two months. Dean answers, "Never."
He asks if the patients reported seeing anything weird. "In here?" she says. "All the time."
"So," she continues, leaning in. "Let's talk about your father." Dean tenses up.
Later on, Sam encounters Dean brooding in the hall and Dean tells him, "I just got theraped." Sam tells him about the patient in group. Dean's heartened by this and wants to start the investigation, because the sooner they can solve the problem, the sooner they can leave. "This place gives me the creeps," Dean mutters, turning around to come face to face with a very attractive woman who greets him with a deep kiss before she even says hi. Dean, of course, is intrigued. She pats his butt before walking off and Sam has to talk him down: "Dude...you cannot hit that."
"...So torn!" Dean whines.
Night falls, and the boys break out of their rooms to find the patient who allegedly saw the monster before the nurses on rounds can discover they're out of their beds. But by the time they get to the guy, he's already screaming...and his feet are kicking against the window in the door. The boys snipe at each other as Sam picks the lock, but by the time they get in it's too late. The man appears to have hung himself.
The Winchesters are able to examine his body later on by sneaking into the morgue (before we quibble about a psychiatric hospital having a full-service morgue, let's remember we're watching a show about demon hunters) and as Sam palpates his neck, he discovers a hole. He inserts a cotton swab and realizes the hole goes all the way up to the man's brain. Noticing a bone saw nearby (we're going with it), Sam decides to examine things further while Dean keeps watch. Surely this will not go well. Dean stands by the door as Sam removes the top of the skull and takes a look at the brain -- which is blackened and seems to have been sucked dry.
As he find this out, Dean hears someone coming and runs in to help Sam replace the body in the fridge and toss out his bloody examination gloves. This all occurs a mere moment before the attractive intake nurse discovers them. The nurse asks what they're doing and, for a moment they're at a loss for words until Dean drops his pants, throws his hands up into the air and yells, "Pudding!" The nurse rolls her eyes and escorts them back to the day room.
Dean fills Martin in on what they found and asks Martin if he has any ideas...and Martin suddenly realizes what they're up against: A wraith. It's an ugly beast that feeds on brains, which makes a locked-down mental hospital the perfect hunting ground -- who's going to believe any of the patients when they say they've seen a monster? The only thing that can kill it is silver. The bad news is that it can pose as a regular person, which means it could be anyone in the hospital. However, it does show its true reflection in a mirror.
Dean decides to hang out by one of the security mirrors and check out the reflections of everyone who walks by. Dr. Cartwright swings by and asks Dean what he's doing and, of course, he tells her he's hunting a wraith. He also tells her, after checking her reflection, that she's clean. She asks him why he has to hunt demons and he explains, with a grin, "Can't find anybody else that dumb." She looks at him, intrigued. He further explains that it's his job, that he has to save everyone, "the whole wide world of sports."
She asks why he has to save everyone and he tells her it's the Apocalypse, and that he's the only one that can do it. She empathizes, saying that it must be a crushing weight on his shoulders to feel responsible for six billion people.
"God...how do you get up in the morning?" she asks.
Dean ponders that for a moment, then answers, "Good question." The main doctor walks by and greets Dean as Eddie. Dean glances at his reflection in the mirror and -- bingo, the man is our wraith!
Dean and Sam grab silver-plated letter openers they find just sitting in the open at the nurses station, in a psychiatric hospital, and give one to Martin, assuring him it should work. They lay out the plan, explaining that Dr. Wraith is on duty that night, and they'll have to slip past the orderlies and security to get to him. Horny patient walks by and plants one on Sam, telling him he wants him now since he's bigger. They regain focus and enlist Martin, but the ex-Hunter refuses to help them, explaining that he could no longer fool himself into thinking he's invincible. Sam alludes that they know what happened in Albuquerque, but Martin assures him they don't know the half of it. Martin walks off, so Sam and Dean head out alone.
They head to the doctor's office and find his keys, evidence he's still in the building. They split up, each taking a wing. Sam heads to the West wing and sees the doctor making the rounds. He waits around he corner until the doctor comes by, then attacks him with letter opener, cutting him his arm. Three orderlies emerge to subdue him, but Sam quickly fends them off and launches himself at the doctor, moving in for the kill. Before he can plunge the letter opener into the doctor's chest, Martin appears out of nowhere and holds back Sam's hand, pointing out that the wound on the doctor's arm isn't burning. Sam drops the letter opener, horrified. This spells big trouble and, we're guessing, sedatives and restraints.
Dean finds Sam in his room, thoroughly zonked out. "Did they give you something?" Dean asks.
"They gave me everything," Sam says, smiling. Then he grabs Dean and tells him that the doctor isn't a wraith and implies that Dean was seeing things. Maybe Dean has finally cracked and really is crazy. Dean assures him that he's going to find the thing, and Sam druggily tells him that it's OK, because he's still his brother and he loves him.
Dr. Cartwright finds Dean in the hall and asks him if he's OK, commiserating about what a burden it is to feel like he has to save millions of people. After all, he can't save anyone, she says, her tone suddenly becoming cold and accusing, because he opened the seal and failed to kill the devil, right? A horrified Dean begins to yell at Dr. Cartwright, demanding to know who she is. She merely smiles as an orderly behind her orders Dean to calm down. Dean keeps on yelling at Dr. Cartwright, and the orderly warns Dean again. Dean asks the orderly who the doctor really is and the orderly informs Dean that there's nobody there.
Dean, still looking at Dr. Cartwright, suddenly wears an expression of shock. The doctor taunts Dean, saying that nobody can see her because she's in Dean's head, and he really is going crazy. Dean, reeling, stumbles down the hall and notices that everyone's reflection is monstrous. He cowers in a corner.
Meanwhile, the main doctor confronts Sam in his room at Sam's request. Sam apologizes for his attack but can't tell the doctor why he did it. The doctor said that what worries him isn't that Sam thought he was a monster, it's the anger he saw in Sam when he attacked him and the orderlies. He said he'd never seen such terrifying rage before. "When you came after me, it's like you were barely even human. Like a man possessed," the doctor said.
"I know," Sam whispers. "Please...just...could you give me a second chance?"
The doctor tells him it's not a prison and he'll be able to go to the day room under supervision. But if there's another outburst, he'll be transferred to a facility that can handle violent patients and they'll be far less forgiving.
Sam goes back to the day room and finds Dean, who tells him that the problem was never the demon blood -- it was Sam himself. Then the other patients close in on Sam, telling him that they're all going to die because of him. Sam starts swinging at them, attacking them violently -- then the camera pulls back and we see Sam is swinging his fists at nothing, and Dean is actually sitting over in the corner, barely aware of the world around him. The orderlies subdue Sam and take him away as Dean mutters to himself.
Dean finds his way to Martin, telling and showing him that he is going legitimately insane. As Martin gets him to focus, they realize that what's going on is that the wraith isn't just feeding on bad brains, it's using them to drive other people mad. Dean thinks the wraith poisoned them by venom, or saliva...and then he realizes the common link. It's Wendy, the crazy sexy hot girl, who kissed him and Sam. That's what made them crazy!
Martin and Sam head to Wendy's room and, before they enter, hear a familiar scream. Upon entering, they see the friendly cute nurse sitting on top of her. The nurse has a spike protruding out of her wrist, and it's going into Wendy's neck, toward her brain. The nurse's reflection reveals her to be a monster. She retracts the spike and licks it as Dean asks if it's real. "Oh yeah, sugar," she says with a smile. "It's real."
The wraith nurse leaps on Dean and throws Martin to the side, punching Dean relentlessly. Martin grabs the letter opener and cuts her, and the wound sizzles. She screams and runs off, alerting the orderlies that two patients have attacked another patient. Martin tells Dean, who can barely stand let alone walk straight, that he has to stop the nurse. He goes to examine Wendy and discovers that she's still alive, and as the orderlies come in, Martin holds them back and urges Dean to go. He stumbles out into the hall and runs, weaving, after the nurse.
The wraith nurse heads to Sam's rubber room next, where he's fully restrained. He sees her in a reflection and realizes that it's been her all along. She laughs and informs them that hunters don't live up to their reputation...after all, Sam and Dean came in blabbing about demons and she immediately realized who they were. Then all it took was a touch, and they were hers.
Then she raves about how the hospital is like an all-you-can-eat buffet, and how much tastier crazy brains are than regular ones, because they get soaked in dopamine and adrenaline and all sorts of chemicals that make them more delicious. But Sam's, she explains, has the extra benefit of being steeped in rage. That's all his, she adds, saying she has nothing to do with it. "You build your own hell, but I give you the Legos. And when you're ripe --" she says, as the bone spike emerges from her wrist, "---I make all your problems disappear."
Not a moment too soon, Dean bursts into the room, looking like easy pickings because he can't even see straight. The wraith attacks him, pinning him against the wall and moving the spike toward his forehead, as if to lobotomize him, but Dean grabs it and breaks it off. Blood spurts everywhere as she screams in pain, and he plunges the letter opener into her chest. The monster slides down the wall and as she dies, Sam and Dean return to normal. Dean releases Sam from the straps just as the alarms go off in the hospital.
Fortunately, the hospital has the most lax security in the history of life, because the boys find a back door and run for it, right back to the Metallicar.
"Looks like Tom Cruise was right -- shrinks suck!" Dean quips, but Sam seems lost in thought about something. Dean asks if he's OK, and Sam says no, that the wraith was right. That most of the time he can hide it, but he's enraged at everything, all the time, and he doesn't know why. "So what if you are?" Dean says. "What are you going to do, take a leave of absence? Are you going to say yes to Lucifer?" Sam says no, of course not. Dean tells him he needs to bury it, to forget about it, and move on, because that's how they keep going, that's how they don't end up like Martin.
"Are you with me? Come on, man...are you with me?" Dean asks. Sam says, "I'm with you." But he doesn't look so sure.
He gets into the car with Dean, and they drive off into the night.