The Catholic Church does not understand the "murdered souls" and profound spiritual damage done to children sexually abused by priests and religious, a US priest and expert says.
Dominican priest Dr Thomas Doyle, who has worked with thousands of abuse survivors, says the pastoral care of victims is a massive hole in the church's approach.
Dr Doyle says because of the church's teachings on human sexuality, many clerics and church leaders are unable to comprehend the damage that child sexual abuse or the rape of an adult does to an individual.
"They don't comprehend what has happened to those victims," Dr Doyle told the child abuse royal commission on Tuesday.
"That's never going to go away.
"That's soul murder and sometimes those murdered souls stay dead."
Dr Doyle said his three decades working with survivors has revealed the profound spiritual damage done to victims from devout Catholic families.
"One of the massive holes in the Roman Catholic Church's approach to this issue still today is a failure to completely comprehend the depth of the spiritual damage that is done to the victims, to their families, especially their parents, their friends and to the community itself," he said.
"I've never seen anything coming out of the Holy See dealing with the spiritual damage.
"All I've seen is 'get them to go back to church', which is nuts, that's crazy."
The church has to take care of the victims, said Dr Doyle, who was sacked from his position in the Vatican embassy in Washington in 1986 after he "stood up to the system".
"The issue today for the church is the pastoral care and the support and the love of the hundreds of thousands of men and women who they have violated spiritually and physically over the years," he said.
"It's not enough to say give them money to go to psychologists."
