Like Dodge, but with a chance to hurt the enemy! What could go wrong?
Well, in my experience quite a bit. First of all it's much more expensive than dodge is, which can cause extreme opportunity cost as you have to choose between taking damage now, and having a better board setup next turn. Furthermore the reflected damage is not guaranteed, which kind of negates a huge amount of this card's benefit.
Now, in theory you can run a sadism run where (Slight campaign mechanic spoilers) ------ you intentionally fill the bag with these negative nancy tokens (... not as bad an idea as it sounds on Expert difficulty) ------ and I can't comment on the strength of this card then, but in a more vanilla run it can be pretty unlikely to trigger.
I think, like Song of the Dead without a better way to control the chaos bag, extremely swingy cards are going to remain cool in theory, but bad in practice.