At this point in the play, Lady Macbeth is not in her
right mind. The doctor has already told Macbeth that he can't cure what is wrong with
her.
The Thane of Fife was Lady Macduff. Macbeth had her
and her children murdered. Lady Macbeth imagines that she sees the blood of Duncan (and
Macbeth's other victims) on her hands. If you remember, she returned the bloody daggers
after Macbeth killed Duncan and by mistake did not leave them with the drugged grooms.
It was necessary for her to literally get the blood on her hands. Her guilt drives her
insane and she sees the evidence of her guilt, the blood, on her hands. It is not
literal blood at this point. The blood becomes metaphorical, a symbol of her guilt.
Since she planned Duncan's murder and pushed him to do it, she is just as guilty as
Macbeth of the bloodbath that followed.
Her guilt
eventually drove her to commit suicide.
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