"No," Sam said grimly. "Not even after he got back from hell."
And when he said it aloud, he realized how much that said about the nature of whatever had happened to Dean. Hell had done a number on Dean; he'd come back broken and beaten, his faith in himself lost. Some of that seemed to have come back, a little, but Sam still saw a lot of despair and hopelessness in him. The years to come didn't sound like they'd be any easier on him, but none of it explained the screams.
He looked at Cas. "We've got to do something about it, haven't we?"