I think Dean's comment at the end about sometimes something possesses you and it just takes over (or something, I'm paraphrasing) and his earlier comment about 'having power over other lives because you have none over your own' were both very telling about where Dean's headspace is now.
/random post-episode comment.

Dean is getting very uncomfortable with this, to the point of almost asking 'how long is this going to take?' in that opening scene in the batcave.

Sam knows something is off, but he's getting 8 hours of sleep a night, he feels good, he's in a good space and he trusts Dean. He doesn't *want* anything to be wrong.

*sobs*