Wow, I really liked this episode. I was worried it was going to be cracky premise and no substance, but this was a truly good horror episode that didn't squick me too badly. When the guys started to go nuts it reminded me of all that time playing Eternal Darkness (way back for the GameCube) when there were times you couldn't believe your perceptions...
When the episode first started I initially questioned the portrayal of the mental hospital. My only experience is with visiting a friend, so I'm not an expert. But I do doubt they'd diagnose someone as a paranoid schizophrenic within five minutes of meeting them.
At first I did think the wraith was the doc with his "there are no such thing as monsters..." but the nurse pinged my radar in the beginning cause she was just too darn nice. Despite her anal probe of the boys:)
I really also liked Dean speaking to the imaginary therapist. It's like his dream doctor would be a good looking woman who really go into his emotional issues. "Let's talk about your dad..." "It really must be hard for you to have the weight of the world on your shoulders..."
I do regret that we missed out on Dean in group therapy. I'm looking forward to whatever missing scene fic results from that!
Oh, and just when the heck did Sam go to medical school? lapillus suggested that he started out pre-med, which would explain the age issue. However, you really don't get to A and P till much later in the program.... I really don't think it's standard curiculum to teach how to cut people's head's open and examine their brains!
And despite Dean's advice "we push it all down and keep going..." which I think is bad, it's putting them back together, as SamANDDean. "Are you with me?" because without Sam, Dean can't do this himself...