Designer Diary time.
I was not totally excited that Inner Struggle was chosen as a comeback card.
I had been hit with it a few times - even in multiples, and languished under the reduced hand ranks that would result.
Since the Weird West Environment only has one way to get rid of Inner Struggle, HERE I was worried about creating a negative play experience.
There were several iterations, some with innate ways to go to therapy and resolve your Inner Struggle. Some got rather complex and wordy. In the end, my play test team put forth the idea of all of the aspects of the original card, just without the ongoing effect triggering on lowball.
The initial play of the card does still give the player a 1 rank advantage for a turn if played on lowball. One rank is not much on the original play, but if it is enough to weather the pain, you then want to force multiple shootout rounds.
Combining with other Cheatin' Resolutions or in-play Cheatin' Resolutions (Goods, because you do not want aces when you are casting spells) makes this card extra oppressive.
under normal circumstances, conventional wisdom is that a Full House is the expectation in a shootout - under the effects of an Inner Struggle you now lose to that floor level. To combat this, you may need to cheat to four or five of a kind. When an additional layer of cheatin' punishment is then added on ... bad things happen. Or just avoid fights on a Struggle turn.