The Born-Again Identity is the 17th episode of Season 7. It aired on March 23, 2012.
Lucifer drives Sam to the breaking point and Sam ends up in a mental hospital. Desperate to save his brother, Dean calls every hunter he knows for help. One of the hunters gives him the name of a healer who turns out to have a very familiar face.
A sleep-deprived Sam is running down railroad tracks and into an alleyway, and a drug dealer tells him to go away. Lucifer keeps talking to Sam, keeping him awake. When Sam tries to walk away, the dealer offers him something to doze off. Sam takes it and tries to go to sleep, but jerks awake. Lucifer is still there, and when Sam tries to run away from him, he enters traffic and is hit by a car.
Dean arrives at the hospital and asks to see his brother, Dr. Kadinsky explains that Sam has had a psychotic episode and is locked up on their psychiatric floor. They are observing him so that they can determine how to treat him, and Dean tells Kadinsky that the non-sleep thing is new. Kadinsky takes Dean to see Sam, who is resisting the sedatives. Sam is still seeing Lucifer, and Dean tells him that he'll get him help. Sam isn't convinced, reminding him that the last healer they found was using a Reaper, and tells Dean not to bother because there's no hope. Dean considers and then walks out.
Back at the motel, Dean calls everyone that he can to find help using Bobby's journal. He has no luck and goes to get a beer, and a light wind blows the card of Mackey's Taxidermy Shop out of the journal. After a moment, Dean leaves a message at the shop's answering machine.
Lucifer continues to haunt Sam, who meets with Kadinsky. The doctor informs him that he is preparing Sam for torture and then transforms into Lucifer, who reminds him that the locked ward is just like the cage they spent together in Hell. That night, Sam tries to eat but sees maggots crawling in his food. He looks up and sees a female patient look at him briefly before walking away.
Mackey finally calls Dean back and says that he's heard of a man named Emanuel Allen who roams around healing people. The hunter figured that Emanuel was a monster and called the healer's wife, Daphne. She told Mackey that Emanuel would see him, and Emanuel came to see him, bypassing all of his tests and traps. Emanuel healed Mackey's injured right eye and tells Dean that he's convinced the man is real.
The woman, Marin, comes to see Sam and offers him a candy bar before leaving.
Dean goes to Daphne's home and asks for Emanuel. A man greets him at the door and says that Daphne is resting. However, Dean sees Daphne tied up and the man reveals that he's a demon and attacks. Dean stabs him with the demon-killing knife and then discovers that Emanuel has arrived and he looks just like Castiel.
Emanuel goes inside and frees Daphne, and explains that he saw the demon's real face. Dean explains that there are numerous demons and is surprised that Emanuel knows nothing about them, and asks him to help Sam.
At the psych ward, Lucifer continues to keep Sam awake and boasts that his madness has won. An orderly, Marcus, comes in with food and Sam asks him about Marin. The orderly refuses to talk about Marin but says that she didn't come there due to an accident. Once he leaves, Lucifer goes back to setting off firecrackers.
As Dean drives Emanuel to the hospital, he asks about Daphne. Emanuel explains that she was out hiking when she stumbled across him, naked and confused and wandering in the woods. She claimed that God led her to him, and Emanuel has no memories of his life before that. However, he says that he doesn't feel like he might have been a bad person.
Marin comes to see Sam, who is still struggling to stay awake. She leaves him a stolen candy bar and starts to go, and Sam invites her to stay and share. Marin accepts and says that she's been there five weeks. He notices the bandages on her neck and asks what the matter is, and Marin tells him that she feels depressed and suicidal, and wants everything to be over for her. She asks about Sam and he admits that a voice is keeping him awake, and Marin says that she hears a voice as well. Sam notices on her burns, asking if the voice told her to do it, and Marin insists that her dead brother was the one who set the fires and wants her kill herself to be with him, or he'll do it for her.
Emanuel asks about Sam's problem and says that he can cure spiritual illnesses as well as physical ones. He realizes that Dean is angry and that the person responsible for Sam's current condition betrayed him, and senses that he's killed a lot of people. Looking at Emanuel, Dean says that he thought that the person responsible is dead. He mentions Castiel by name and says that he's having trouble dealing with it, and Emanuel assures him that he's only human. He doesn't respond to the name "Cas" other than to say that it's unusual.
The next morning, Dean stops at a convenience store to make a call on his cell phone and has Emanuel wait in the car. Inside, a demon attacks him and he kills it with the knife. The phone is destroyed in the fight, and two more demons come at Dean. They attack him and Dean drops the knife, but someone comes in, stabs one, and drives the other one out. However, a surprised Dean realizes that it's Meg, not Emanuel.
Meg explains that she has been tracking down Emanuel and was surprised to discover that he looks like Castiel. Dean tells her not to give anything away and Meg admits that she's still not on good terms with Crowley. She promises to dispose of Crowley, but admits that right now there's a price on her head and she needs friends. Dean isn't interested, figuring that Meg wants to turn Emanuel into a weapon, but she figures that it's in their best interests to work together. Dean agrees but says that they're going to Sam first, and then asks for his knife back. Outside, Emanuel recognizes Meg as a demon but Dean tells him that she's a friend of sorts. She hints that she's met Emanuel before and starts flirting with him, and Dean gets them on the road.
Sam approaches Marin in the hall, apologizes for upsetting her, and asks her about the fire. He assures her that he believes she didn't start it, and offers to help her deal with her brother. Lucifer watches, smirking, as Sam asks Marin about her brother. She explains that he died a year ago and only she can hear him, and she feels chills when he manifests. When Sam says that it must have felt good to hear her dead brother at first, Marin admits that she missed him and it felt good, but then her brother started to get mad and yell at her. Sam says that he can banish the ghost and that Marin has to trust him because it's her only chance. Marin shows him a string bracelet that her brother gave her, that he bled on, and Sam asks if she has a lighter.
Meg and Dean travel in silence and Emanuel finally asks if there's something he should know. They insist that they don't.
Marin returns with a lighter that she stole from the orderly, and Sam creates a circle of salt. Lucifer blows it away and Sam tells Marin that she will have to do it on her own. Once she rebuilds the circle, Sam gets into it with her. The ghost of her brother appears and begs her not to do it, but Marin says that she has to. Sam takes the bracelet and burns it and the spirit disappears, and then tells Marin to go. She thanks him and leaves, just as the orderlies arrive and sedate him. Later, Sam wakes up and Kadinsky examines him, and says that they have to consider a surgical solution.
Dean, Emanuel, and Meg arrive outside the hospital and discover that demons have surrounded the building. Emanuel and Meg both wonder what Dean plans to do, and Dean pulls Meg off to the side. She wants to tell Emanuel who he really is, even though they don't know how he will react. Emanuel hears them and comes over, and Meg tells him that he's an angel. Emanuel wonders why they wouldn't tell him, and Dean says that it's bloody and corrupt. When Meg says that Dean and Emanuel used to be friends, Emanuel admits that he doesn't remember Dean. Meg tells him to smite every demon in the parking lot, but Emanuel says that he doesn't remember how. He finally agrees to try, but Dean doesn't think it will work out well.
Emanuel walks into the parking lot and touches one of the demons on the head. His hands glow with angelic fire and Emanuel/Castiel starts to remember everything. He disposes of the other demons in short order, and Dean and Meg come down. Castiel turns to them and says that he remembers everything. He asks why Dean didn't tell him that Sam is dying because of him, and walks away, blaming himself for everything.
Marcus takes Sam to a treatment theater and explains that they're going to perform electroshock therapy. He then turns the device up to full and puts the headpiece on him, and reveals that he's a demon.
Dean tells Castiel that he did the best he could at the time, but Castiel says that there's no defense for what he did. He reminds Dean that they didn't part as friends and deserves to die, and wonders why he walked out of the river if he couldn't fix things. Dean says that maybe he came back so he could fix things, and brings out Castiel's trenchcoat and gives it to Cas.
Marcus continues torturing Sam, but Castiel arrives and kills him. He switches off the power and apologizes to Sam for breaking the wall in his mind, and then touches his forehead in an attempt to put the wall back. Sam sees him as Lucifer and insists that he's not real, while Castiel says that he's sorry.
Later, Dean and Castiel visit Sam, who is still seeing Lucifer and has withdrawn entirely from reality. Castiel explains that Sam's mind is too far gone and he can't fix it. However, he realizes that he can shift the problem. He tells Dean that it's better that way, touches Sam's head, and draws red veins of energy into his own body. Sam snaps back to normal but now Castiel sees Lucifer and backs up in horror.
Sam and Dean have no choice but to leave the hospital, leaving Castiel behind as a patient for his own safety. Sam isn't convinced that working with Meg is a good idea, but Dean warns him that they don't have a choice. Meanwhile, Meg meets with Kadinsky and convinces him that he should hire her as a nurse at the hospital.
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