Hans von Bülow called the prelude "suffocation", due to its sense of despair. In fact, Chopin's last dynamic marking in the piece is smorzando, which means "dying away". But the prelude may have once been given a title. According to George Sand's daughter Solange, who stayed with the composer at the monastery in Majorca when the preludes were written, "My mother gave a title to each of Chopin’s wonderful Preludes; these titles have been preserved on a score he gave to us."  That titled score is lost. But Solange did record the names of the preludes, apparently without assigning the names to the prelude numbers. It is believed that the title "Quelles larmes au fond du cloître humide?" ("What tears [are shed] from the depths of the damp monastery?") corresponds to Prelude No. 4.
This piece is featured in The West Wing Episode Han, and is used as the embodiment of Han, for which "There is no literal English translation. It's a state of mind. Of soul, really. A sadness. A sadness so deep no tears will come. And yet still there's hope."
The 2002 film The Pianist has this composition on its soundtrack.
It is included on the soundtrack to the 2004 film The Notebook.