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The first thing you should know about the documentary “Lake of Fire” — an unblinking look at the violent fight over abortion in the United States, including those homegrown religious fundamentalists who kill in the name of God — is that it was made in black and white. This is critical. Because the other thing you should know about this fascinating, discomfiting, at times unpleasant, confused and confusing film is that it sets off extremely graphic images of actual abortions against a notorious photograph of a woman who died after an illegal motel room abortion, visuals that are inflammatory if, for the most part, also germane.

Not everyone will agree about the abortion visuals, including, perhaps, those who worry that such explicit imagery can speak louder than any pro-abortion-rights argument. It’s an understandable concern. Because they are filmed (the dead woman is immortalized in a still photograph), the abortions are unnerving, which is why I suggest that the faint of heart skip the rest of this paragraph. After the first operation, a second-trimester abortion, the doctor sorts through a tray of fetal parts, including a perfect-looking tiny hand and a foot, to make sure that nothing has been left inside the patient, which might lead to poisoning or even death. The doctor then holds up the severed fetal head. One eerily bulging eye looks as if it’s staring into the camera and somehow at us.

My initial and admittedly angry first thought about these images was that the director, Tony Kaye, was just resorting to shock tactics. The film doesn’t employ narration or on-screen texts that reveal his views on abortion; instead, there are 152 minutes of talking-head testimonials, on-the-street interviews and archival and new visuals. This means that you have to pay extra-special attention to his filmmaking choices, to the way he juxtaposes sights and sounds and who gets to speak and when.

His choices can be baffling. The ludicrous opening credits (anguished music, candles shaped like praying hands) could be straight out of a cheap horror flick, though the later presence of heavyweights like Noam Chomsky points to more sober ambitions.

The British-born Mr. Kaye started his life in images by directing commercials, a form that relies on bold visuals and simple messages. He went on to direct the flashy “American History X” (1998], about a charismatic neo-Nazi, though he lost control of the project to its star, Edward Norton. Mr. Kaye began shooting material for “Lake of Fire” (the title refers to hell) in the early 1990s, a process that consumed an uncommonly long 16 years. He has stated that he was interested in making a “socially conscious” dramatic film, but decided to make a documentary that would represent the issue in its complexity, despite knowing nothing about the form. His ignorance has its dividends. Shot primarily in sumptuous, often disquietingly beautiful 35-millimeter film, “Lake of Fire” doesn’t look anything like most American documentaries.

The decision to use black and white was smart because, as with “Schindler’s List,” too much red might well have sent audiences fleeing from theaters. The absence of color blunts the force of the images (the sounds of the machinery are still unsettling), which allows you to watch the movie rather than avert your gaze and your rattled mind. Mr. Kaye has an irritating, sometimes self-undermining weakness for shocking visuals (and edits), but it’s clear from all the time he spent on this project and from the different voices he’s gathered that he was genuinely interested in making a serious work, one that explores its subject with far more depth and breadth than the usual run-and-gun documentaries.

In the main, he has succeeded, notably through an array of mostly male journalists, activists, ministers, lawyers and academics, including the philosopher Peter Singer and the writer Nat Hentoff, who lay out the arguments and scan the terrain. Some sound rational, coolly dispassionate; others smile and spew. A few of the more vivid characters, specifically religious extremists who believe that America should be a Christian nation and that abortion providers should be executed alongside homosexuals, adulterers and blasphemers, are, well, something else. Intentionally or not, Mr. Kaye has made a documentary that vividly delineates how religious-fundamentalist terrorists take root in a country, slide around the law and gain legitimacy (martyrdom), and how those who profess to love God can justify murder.

Which leads me back to some of the more shocking images in “Lake of Fire.” It’s possible that Mr. Kaye opted to show several abortions because he wanted viewers, particularly those sympathetic to a woman’s right to abortion, to understand what stirs some people not just to action, but also to kill doctors. If nothing else, the first abortion in the film (of a 20-week-old fetus, though that information is not in the film) reinforces what an abstraction the term pro-choice really is. Abortion does end the life of something. The fight, of course, is over what that something is — an embryo, a baby, God’s creation, a blob of cells — and who has dominion over it and the fully formed human being carrying that something inside her body.

I wish there were more of those fully formed human beings in “Lake of Fire,” which has an awful lot of men talking about what women should and should not do with their bodies. There are women here, to be sure, though it may be instructive that one of the most memorable female voices belongs to an unreliable witness who talks about seeing “babies” stacked in an abortion-clinic freezer. Mr. Kaye follows this startling testimonial with otherworldly and unidentified images of intact late-term fetuses or babies or maybe even dolls. Because I couldn’t tell what I was looking at, I asked the film’s distributor. According to the company, these images had been given to Mr. Kaye by members of the anti-abortion group Operation Rescue.

One lesson of “Lake of Fire” is the galvanizing power of the visual image. Sometimes a picture is worth a thousand words, and sometimes pictures are not enough. Although the film doesn’t identify her, the dead woman in the photograph that Mr. Kaye shows us late in the film is Gerri Santoro. In 1964, when abortion was not yet a constitutional right, she and a male lover checked into a Connecticut motel room, where he tried to perform an abortion. She had become pregnant and feared that her estranged husband, who beat her and their children, would find out. Something went wrong, and the lover fled. Ms. Santoro died, smeared in blood, defeated, naked and alone. Before she was a symbol, she was a person.

LAKE OF FIRE

Opens today in Manhattan.

Produced and directed by Tony Kaye; director of photography, Mr. Kaye; edited by Peter Goddard; music by Anne Dudley; released by ThinkFilm. At Film Forum, 209 West Houston Street, west of Avenue of the Americas, South Village. Running time: 152 minutes. This film is not rated.

With: Alan M. Dershowitz, Noam Chomsky, Nat Hentoff, Dallas A. Blanchard, Norma McCorvey, Peter Singer, Randall Terry, Frederick Clarkson, Bill Baird, Frances Kissling, Michael Griffin and Paul Jennings Hill.

WARNING!!!!!!!!!!EXPLICIT ABORTION FOOTAGE