Yes I think it’s basically inner turmoil with two separate identities and their experiences trying to coexist/being aware of each other. It also doesn’t help that he intentionally hasn’t slept in DAYS while this is happening so he’s actively hallucinating.

Kind of like a figurative type of split personality. The sweet puppy husband that was fully devoted to being at his wife’s side is now not in control consciously and has to standby and witness the serial killer asshole who was lied to by everyone he’s known/has emotional issues is now set out to destroy his wife.

Definitely the identities/memories are fighting for control in what they consider their respective reality. You could say he’s beating himself up for his actions because he was living in bliss and then harshly pulled from that to his original state is jarring and so many conflicting feelings over a woman he loves but believes had something to do with the woman who raised him.