Some of the settings there are absolute killers. Volumetric coulds is nuts. The game is 90% staring at the ground, and I lose 10+ fps with that. Ditto for transparent reflections, and the settings for global illumination on high are insane as well.
Sure, once you tune it down selectively it looks like CS1... but it also performs like it.
I really don't understand some of the choices they made here, either in the way the visuals work, the way the default settings work or the way they communicated it. If they hadn't come out saying it'd be super heavy and they renamed "high" to "ultra" or had an intermediate setup between medium and high they wouldn't be getting this much crap.