This is new to me, where does he say this specifically?
Not to white knight Casey but his niche has been in rendering and graphics afaik , where everything he does have to fit inbetween frames, so it makes sense to be a "performance maximalist" in that environment.
It could be that you and he are working on different sets of problems with different tools.
But I'd be really interested I where he says you must write unmaintainable code.
Also (my take) : if you're looking at "clean code" to find abstractions that allow things to be refactored, then I think that's probably not the type of performance he's talking about for you. LLMs can do that type of work. FWIW I think he refactors from what things ought to be, not how they are currently