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This action is simply apart of Lady Macbeth's sleepwalking. She has become so disturbed and full of guilt because of the knowledge that she and her husband murdered the King that she can no longer sleep. Instead, she nightly gets out of bed, writes on paper, "washes" her hands, and talks about the murder. In this scene, her nurse and a doctor are watching her. The doctor is there to try and help Lady Macbeth, but in the end he comments that her distress is a sickness of the mind and he does not have the medicine for it.
It was in a letter she received from her husband in Act 1, sc. 5, that Lady Macbeth became aware of the witchs' prophecies for her husband. As soon as she read his account of his encounter with the witches, she became determined that Macbeth would become king. It was then that she summoned the spirits to "...fill me from the crown to the toe top-full /
Of direst cruelty! " and to make her blood "thick" so that she'd have whatever it would take to make sure her husband became king. The play comes full-circle now, as Lady Macbeth continues to fold and unfold a letter in her state of madness. The spirits did indeed give her the will to plan a murder but she lacked the ability to stave off the guilt.
In this scene, a Lady in Waiting reports that before the scene began she had witnessed a psychotic, sleep walking Lady Macbeth take a paper, write on it, read it, seal it, and then return to bed. It seems likely that Lady Macbeth was writing statements on the paper that declare her role and guilt over the killings of Duncan and Banquo. Later in the scene, in front of the Doctor and the Lady in waiting, she makes additional comments that confirm her guilt.
Lady Macbeth's letter-writting is analogous to her emotional state. She "unlock(s) her closet" and presumably confesses her feelings into the letter she writes. This is analogous with Lady Macbeth unlocking her heart and pouring forth fears and anxieties she cannot confide to anyone during waking hours -- even her husband is away ("His Majesty went into the field"). It is only during night-time that her pent-up emotions find expression.
However, she always "seal(s)" up her letters, then return to bed as if nothing happened. This is just what Lady Macbeth emotionally has to do -- after briefly revealing her dark secrets, she has to promptly lock them back deep inside her heart again lest they be known to the others.
The correspondence between Lady Macbeth's behaviour and inner feelings is again seen in her act of washing. While outwardly she rubs her hand, it is in fact analogous with her desire to cleanse her mind of dark thoughts and emotions.
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