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I believe that Macbeth could not say amen, because he had a mental barrier. He could not say the word because he realized he could not comprehend what he had done.

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Macbeth is overrun with guilt and suspicion, which causes him to psychologically  imagine the voices.

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This speech preludes the fact that though Macbeth wanted the crown, his mind was at war for he thought of Duncan as a friend.

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The death of MacDuff's family greatly effected McDuff.

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The death of MacDuff's family greatly effected McDuff.

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MacDuff's thought process, when he learns about his family's murder, turns to one that must avenge them and murder Macbeth.

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Sleep deprived and going crazy, it can be inferred that Lady Macbeth killed herself. All the problems she had faced as queen and her guilt for doing it most likely drove her to the edg

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After all the previous events, Macbeth is riddled with all sorts of psychological problems. He has established that he must murder anyone who might stand between him and his kingdom.

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Macbeth seeing Banquo's ghost is a sign that Macbeth is completely consumed in paranoia and guilt for murdering his friend and colleague.