But the Physical Symptoms are a Result of Said Abuse
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"Dean expected Sam to find a way to cope after he was dragged to Hell. By no means did he, even for a moment, think Sam might look to parenting as a coping mechanism."
Sam and Liam are on a Walmart run when Castiel whisks Dean away to 1973. Sam and Liam restock necessary supplies, such as soft things and slinkies, and would have returned home to find Dean missing... but then Ruby. Just Ruby.
- Part 3 of Bright Smiles and Bloody Lips