Ever since getting his wall broken, Sam’s #1 goal has been being there for Dean (“You know me. You know why. I’m not leaving my brother out there alone.”). He was desperate that his problems not make things worse for Dean (“You got a lot of pretty severe crap swinging your way lately, and -- and I thought --what? I thought why burst the one good bubble you had left? It's under control.”), to the point of making a very unwise decision and hiding his problems from Dean and Bobby.
Even in the witch episode, Sam tells Dean, “You can unload. That's kind of what I'm here for.” The very point of Sam’s existence, at this particular period in his life, is to be there for Dean.
And Dean throws in his face that he failed. That his mental issues fucked things over for Dean.
On Dean's end, I think the feelings are real. Of course it’s not fair to blame your brother for falling apart when he was hallucinating the devil who tortured and raped him for a length of time too ridiculous to mention here. And of course if your brother points a loaded gun at you because of mental issues that he previously deliberately hid from you, it's going to hurt, anyway.
But Dean in The Mentalists is not just expressing his feelings. He took those very real feelings and stored them up. And then, when Sam was not falling in line the way he wanted Sam to, he used those feelings in a very subtle victim-blamey way to coerce Sam into falling in line.
And it works. And it works again, in PPMM, when a mere reference to Sam’s mental illness is enough to get Sam to shut up about something Dean doesn’t want to hear about.
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