It's unlikely there will ever be a definitive answer to the question of why Seung-Hui Cho went on a shooting rampage at Virginia Tech on April 16, killing 32 people. But a new state report on the attack—along with reporting by PEOPLE—finally offers a detailed account of Cho's background, one that reveals more about his psychological troubles, as well as the many efforts that were made over the years to help him. Said Virginia Gov. Tim Kaine: "Connecting some of the mental health dots might have averted the tragedy."

Investigators traced the first of those dots back to infancy, when doctors in Korea, where Cho was born, told his family he had a hole in his heart. At age 3 he underwent a cardiac procedure that caused the youngster "emotional trauma," according to the report. "From that point on, Cho did not like to be touched." His family's move to the United States when Cho was 8 years old did not help matters. True, he enrolled in a martial arts program and played nonviolent video games exclusively. But by the time he was in middle school he was so shy and withdrawn he had no friends and hardly spoke to anyone. "He never made eye contact," says Robert Nuon, a classmate at Stone Middle School. "It was so sad. You wanted to reach out to him, give him a hug."

He did get professional help. The summer before seventh grade, his parents, concerned about his lack of social skills, took him for art therapy to try and get him to open up. According to the report, he made a house of clay; it had no windows or doors. In 1999, after he wrote a disturbing paper for English class about how he wanted to repeat the Columbine killings, his parents again intervened. They took him to a psychiatrist, Dr. James Griffith, who diagnosed him with social anxiety, depression and selective mutism, in which at times the anxiety is so severe the patient is unable to speak. Griffith gives the Cho family considerable credit for doing everything to get help for their son. "They consistently and reliably brought him every week," Griffith told People. The family was also dealing with another factor that was affecting their son: His older sister Sun, with whom he maintained at least minimal communication, was about to head off to college at Princeton. "His main relationship and connection to the outside world was his sister, and she was leaving," says Griffith. Cho took an antidepressant for a year and attended weekly therapy until 11th grade. He seemed to improve, but then he stopped.

While a smaller, more individualized college may have been a better fit for Cho—that's what his high school guidance counselor suggested—he instead chose Virginia Tech, where his isolation deepened. He had several phone contacts with the campus counseling center. After threatening to commit suicide he was involuntarily committed to a hospital, where he was evaluated and deemed not dangerous. A judge ordered him to receive outpatient treatment, but Cho skipped out after the first session and the counseling center did not follow up. (The report, which was designed to review the facts of the case and suggest improvements in procedures, also faulted the university for not spreading a wider alert more quickly after discovering two of Cho's victims earlier in the day.)

Still, other students did reach out to him, including a suitemate who took him along to a party and afterward to a girl's room. The festivities ended abruptly when Cho pulled out a knife and stabbed the carpet repeatedly. "That was probably the last time we took him out to party," says suite-mate Andy Koch. One female student at Virginia Tech became so intrigued by Cho, with whom she was in a playwriting class, that one day she decided to play "Nancy Drew," she says, and follow him to see where he went. "It seemed that no person could possibly live in such isolation," she told PEOPLE. "I believed he simply had to have a social side to him." As it turned out she quickly lost Cho on campus. "It scares me to think of what might have happened had he known," says the young woman, one of whose friends was killed by Cho.

  • Contributors:
  • Reported by Wendy Grossman/Washington,
  • D.C.,
  • Susan Keating/Centreville,
  • Va.,
  • Rachel Teitelbaum/New York City.