How is the theme of guilt portrayed and explored in Act 5 scene 1 in Macbeth

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In this scene, Lady Macbeth reveals her guilt through her actions while she walks in her sleep. The scene opens with one of Lady Macbeth's servants consulting a doctor about the worrisome sleepwalking. The two watch as the sleepwalking Lady Macbeth compulsiviely washes her hands. The servant tells the doctor that Lady Macbeth will sometimes "continue in this a quarter of an hour."

As she washes, Lady Macbeth says "out damned spot" and wonders that the "old man" had so much blood in him. Her unconscious need to wash off Duncan's blood, and her unconscious conviction that she can never wash the blood or its scent away, both reveal the guilt she feels. The doctor says she is carrying something heavy on her heart. Lady Macbeth goes on, in her sleep, to say that Banquo cannot come out of his grave, once again displaying her guilt as well as her subconscious fear that he can come back to haunt her. 

The doctor judges that Lady Macbeth has an uneasy conscience, saying:

Infected minds
To their deaf pillows will discharge their secrets.
More needs she the divine than the physician.
 
When he says she needs "more needs the divine that the physician," he understands that she is suffering from a spiritual or psychological malady, not a physical problem that he can solve.